[Meta-analysis of surgery trials in refractory epilepsy].

OBJECTIVE To examine the evidence for efficacy of surgery in the treatment of intractable epilepsy. METHOD Meta-analysis of randomized clinical trials. RESULTS One randomized clinical trial (n=80) and 3 observational studies are available. INTERPRETATION Compared to medical treatment, the surgery increases the proportion of patients who were free of seizure impairing awareness at 1 year (relative risk: 7.67, IC 95% 2.5 à 23.51) CONCLUSION The available evidence about the clinical efficacy of surgery for patient with intractable epilepsies is limited to an unique open randomized clinical trial, that enrolled patient in a single centre, without concealment of the randomization and with a partially subjective primary endpoint. However, this trial shows a substantial effect corresponding to a 8 fold increase in the number of patient without seizure at 1 year. The informational situation will be better when the results of a currently ongoing trial will be available.