Resective Epilepsy Surgery for Tuberous Sclerosis in Children: Determining Predictors of Seizure Outcomes in a Multicenter Retrospective Cohort Study

Aria Fallah, Shaun D. Rodgers, Alexander G. Weil, Sumeet Vadera, Seyed Alireza Mansouri, Mary B. Connolly, Philippe Major, Tracy Ma, Orrin Devinsky, Howard L. Weiner, Jorge A. Gonzalez-Martinez, William E. Bingaman, Imad Najm, Ajay Gupta, John Ragheb, Sanjiv Bhatia, Paul Steinbok, Christopher D. Witiw, Elysa Widjaja, O. Carter SneadJames T. Rutka

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35 Scopus citations

Abstract

BACKGROUND: There are no established variables that predict the success of curative resective epilepsy surgery in children with tuberous sclerosis complex (TSC). OBJECTIVE: We performed a multicenter observational study to identify preoperative factors associated with seizure outcome in children with TSC undergoing resective epilepsy surgery. METHODS: A retrospective chart review was performed in eligible children at New York Medical Center, Miami Children's Hospital, Cleveland Clinic Foundation, BC Children's Hospital, Hospital for Sick Children, and Sainte-Justine Hospital between January 2005 and December 2013. A time-to-event analysis was performed. The "event" was defined as seizures after resective epilepsy surgery. RESULTS: Seventy-four patients (41 male) were included. The median age of the patients at the time of surgery was 120 months (range, 3-216 months). The median time to seizure recurrence was 24.0 ± 12.7 months. Engel Class I outcome was achieved in 48 (65%) and 37 (50%) patients at 1-and 2-year follow-up, respectively. On univariate analyses, younger age at seizure onset (hazard ratio [HR]: 2.03, 95% confidence interval [CI]: 1.03-4.00, P .04), larger size of predominant tuber (HR: 1.03, 95% CI: 0.99-1.06, P .12), and resection larger than a tuberectomy (HR: 1.86, 95% CI: 0.92-3.74, P .084) were associated with a longer duration of seizure freedom. In multivariate analyses, resection larger than a tuberectomy (HR: 2.90, 95% CI: 1.17-7.18, P .022) was independently associated with a longer duration of seizure freedom. CONCLUSION: In this large consecutive cohort of children with TSC and medically intractable epilepsy, a greater extent of resection (more than just the tuber) is associated with a greater probability of seizure freedom. This suggests that the epileptogenic zone may include the cortex surrounding the presumed offending tuber. ABBREVIATIONS: EEG, electroencephalography EZ, epileptic zone IPD, individual participant data TSC, tuberous sclerosis complex

Original languageEnglish (US)
Pages (from-to)517-524
Number of pages8
JournalNeurosurgery
Volume77
Issue number4
DOIs
StatePublished - Oct 21 2015

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All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Fallah, A., Rodgers, S. D., Weil, A. G., Vadera, S., Mansouri, S. A., Connolly, M. B., Major, P., Ma, T., Devinsky, O., Weiner, H. L., Gonzalez-Martinez, J. A., Bingaman, W. E., Najm, I., Gupta, A., Ragheb, J., Bhatia, S., Steinbok, P., Witiw, C. D., Widjaja, E., ... Rutka, J. T. (2015). Resective Epilepsy Surgery for Tuberous Sclerosis in Children: Determining Predictors of Seizure Outcomes in a Multicenter Retrospective Cohort Study. Neurosurgery, 77(4), 517-524. https://doi.org/10.1227/NEU.0000000000000875