Percorrer por autor "Carvalho, Ruben Lopes"
A mostrar 1 - 2 de 2
Resultados por página
Opções de ordenação
- Hippocampal volume loss in mesial temporal lobe epilepsy: Magnitude and laterality in a meta-analysis of MRI volumetry studiesPublication . Carvalho, Ruben Lopes; Borges, Daniel Filipe; Casalta-Lopes, João; Soares, Joana Isabel; Borges, Daniel FilipeHippocampal atrophy is a defining structural feature of mesial temporal lobe epilepsy (mTLE), yet the magnitude of volume loss and the extent of contralateral involvement vary across magnetic resonance imaging (MRI) studies, limiting quantitative interpretation in clinical practice. We conducted a systematic review and meta-analysis to quantify hippocampal volume reduction in adults with mTLE and assess the consistency of contralateral changes. Following PRISMA 2020 guidelines, we searched six bibliographic databases and different trial registries. Eligible studies included adults with unilateral mTLE who underwent pre-surgical structural MRI with quantitative hippocampal volumetry, as well as healthy controls. Two reviewers independently assessed risk of bias using ROBINS-E. Random-effects meta-analyses pooled mean differences in absolute hippocampal volume (mm ; controls minus patients) for hippocampi ipsilateral and contralateral to the seizure focus. Twenty-eight studies met the inclusion criteria; 23 contributed to the meta-analysis (803 patients, 613 controls). Ipsilateral hippocampal volume was significantly reduced (mean difference 985.2 mm 759.7–1210.7; p < 0.001; I 2 3 , 95% CI =98%). Contralateral volume was also reduced (22 studies; mean difference 198.8 mm 3 , 95% CI 124.4–273.3; p < 0.001; I 2 =85%). Funnel plot inspection and Egger testing showed no evidence of small-study effects. ROBINS-E indicated low to moderate risk of bias overall. Adult mTLE shows marked ipsilateral hippocampal atrophy with a smaller, consistent contralateral reduction, consistent with partial bilateral structural involvement. Pooled estimates provide clinically interpretable reference values for quantitative MRI in presurgical evaluation, though substantial heterogeneity warrants caution.
- The prevalence of post-therapy epilepsy in patients treated for high-grade glial tumors: a systematic review and meta-analysisPublication . Ferreira, Marta Pereira; Carvalho, Ruben Lopes; Soares, Joana Isabel; Casalta‑Lopes, João; Borges, Daniel Filipe; Borges, Daniel Filipe; Soares, Joana I.Gliomas are the most prevalent type of primary brain tumor of the adult central nervous system. High-grade gliomas (HGG) are the most common type of glioma. Epilepsy is often the first clinical manifestation of HGG. Since epilepsy leads to increased morbidity and mortality rates, seizure control is one of the main therapeutic goals for patients with glioma-related epilepsy. Post-therapy epilepsy is observed in a significant percentage of patients, hence, this work aimed to quantify the prevalence of post-therapy epilepsy after HGG treatment. Our search was conducted across PubMed®, EMBASE®, Web of Science™, Cochrane Library, Sicelo and Scopus, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This review included articles published in Portuguese or English that evaluate adult patients with newly diagnosed HGG, who were treated with at least surgery or radiation. Thirty-six studies reporting on 4036 HGG patients were included in our meta-analysis. The mean age ranged from 44 to 73 years. Glioblastoma was the most commonly observed HGG, representing 77,8% of all glioma patients. The pre-treatment seizure frequency was observed in 21,2%. All patients underwent surgery as the main therapy, and 1842 patients received standard adjuvant therapy. We also observed a pooled prevalence of post-therapy seizures of 25.5% (95% confidence interval of [19.9%; 31.1%]). Substantial heterogeneity in all assessed variables was observed. Conducting larger prospective studies with suitable epilepsy diagnostic methods would help provide a more precise estimate of the number of HGG patients who develop post-therapy epilepsy.