Evidence table for systematic reviews
Study reference Design Inclusion Criteria Quality Results Comments

Englot et al., 2013

Systematic review and meta-analyses

All studies were observational case series, and no randomized, controlled trials were identified.

Inclusion criteria:

Reported on at least 10 paediatric patients (age ≤ 19years) undergoing complete or partial temporal lobe resection for epilepsy and if postoperative seizure control was a primary outcome, reported using the Engel or a comparable, classification scheme.

A minimum of 1 year of postoperative

follow-up was required

Exclusion criteria:

If only biopsies were performed, and reviews and registry surveys were excluded to avoid duplication


Not adequate; only PubMed was searched

Selection: Adequate

Quality assessment of individual studies: Not executed 

396 sources trials included on effect of temporal lobectomy for epilepsy in children.

1002 patients (76%) became seizure free after surgery (Engel Class I), whereas 316 (24%) continued to have seizures (Engel Class II–IV). Postsurgical follow-up was available for a minimum of 1 year.

Zhang, 2013

Systematic review and meta-analyses

Types of studies included not specified

Inclusion criteria:

(a) articles published in English, (b) reports with follow-up data collected from ≥5 TSC patients with medical refractory epilepsy undergoing respective surgery, (c) studies with a mean or median follow-up period of ≥1 year, and (d) postoperative seizure outcome measured by Engel’s classification or other comparable scheme.

Exclusion criteria:

studies with any overlapping patient populations from the same center.


Adequate, medline, embase and Cochrane




Quality assessment of individual studies:

Not executed

13 articles included; 7 on surgery and postoperative outcomes and 2 on identifying surgical candidates. Total of 229 participants

136 (59%) patients achieved seizure freedom (Engel class I) and 93 (41%) patients still had seizures (Engel class II-IV).

Seizure onset later than 1 year of age, unilateral focality in interictal or ictal electroencephalography, and lobectomy were significantly associated with a higher rate of seizure freedom.

Mean or median follow up period ≥1 year

West et al., 2015

Systematic review (Cochrane) and meta-analyses

Randomised controlled trials (RCTs), cohort studies or case series

Inclusion criteria:

Studies were prospective or retrospective, included at least 30 participants, a well-defined population (age, sex, seizure type/frequency, duration of epilepsy, aetiology,

magnetic resonance imaging (MRI) diagnosis, surgical findings), an MRI performed in at least 90% of cases and an expected duration of follow-up of at least one year, and reporting an outcome relating to postoperative seizure control

Exclusion criteria:



Adequate Cochrane Epilepsy Group Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE (Ovid), ClinicalTrials.gov and theWorld Health Organization (WHO)

International Clinical Trials Registry Platform (ICTRP).

Selection: Adequate

Quality assessment of individual studies: risk of bias was unclear or high in the RCTs, most remaining studies were retrospective, variable in size, conducted in wide range of countries, wide demographic range of participants, surgical techniques, and different scales to measure outcomes. These studies provided moderate or weak evidence.


177 studies (16,253 participants) investigated the outcome of surgery for epilepsy.

Freedom from seizures: freedom from seizures, one RCT found surgery to be superior to medical treatment, two RCTs found no statistically significant difference between anterior temporal lobectomy (ATL) with or without corpus callosotomy or between 2.5 cm or 3.5 cm ATL resection, and one RCT found total hippocampectomy to be superior to partial hippocampectomy.

Of the 16,253 participants included in this review, 10,518 (65%) achieved a good outcome from surgery; this ranged across studies from 13.5% to 92.5%.

The following prognostic factors were associated with a better post-surgical seizure outcome: an abnormal pre-operativeMRI, no use of intracranial monitoring,complete surgical resection, presence ofmesial temporal sclerosis, concordance of pre-operativeMRI and electroencephalography (EEG), history of febrile seizures, absence of focal cortical dysplasia/malformation of cortical development, presence of tumour, right-sided resection and presence of unilateral interictal spikes.

2016 update