TY - JOUR
T1 - Resective Epilepsy Surgery for Tuberous Sclerosis in Children
T2 - Determining Predictors of Seizure Outcomes in a Multicenter Retrospective Cohort Study
AU - Fallah, Aria
AU - Rodgers, Shaun D.
AU - Weil, Alexander G.
AU - Vadera, Sumeet
AU - Mansouri, Seyed Alireza
AU - Connolly, Mary B.
AU - Major, Philippe
AU - Ma, Tracy
AU - Devinsky, Orrin
AU - Weiner, Howard L.
AU - Gonzalez-Martinez, Jorge A.
AU - Bingaman, William E.
AU - Najm, Imad
AU - Gupta, Ajay
AU - Ragheb, John
AU - Bhatia, Sanjiv
AU - Steinbok, Paul
AU - Witiw, Christopher D.
AU - Widjaja, Elysa
AU - Snead, O. Carter
AU - Rutka, James T.
N1 - Publisher Copyright:
© 2015 by the Congress of Neurological Surgeons.
Copyright:
Copyright 2015 Elsevier B.V., All rights reserved.
PY - 2015/10/21
Y1 - 2015/10/21
N2 - 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
AB - 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
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U2 - 10.1227/NEU.0000000000000875
DO - 10.1227/NEU.0000000000000875
M3 - Article
C2 - 26120800
AN - SCOPUS:84941892056
VL - 77
SP - 517
EP - 524
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 4
ER -