Long-term outcomes of resective epilepsy surgery after invasive presurgical evaluation in children with tuberous sclerosis complex and bilateral multiple lesions

作者：Arya Ravindra; Tenney Jeffrey R; Horn Paul S; Greiner Hansel M; Holland Katherine D; Leach James L; Gelfand Michael J; Rozhkov Leonid; Fujiwara Hisako; Rose Douglas F; Franz David N; Mangano Francesco T^*

来源：Journal of Neurosurgery-Pediatrics, 2015, 15(1): 26-33.

DOI：10.3171/2014.10.PEDS14107

• epilepsy surgery
• medically refractory epilepsy
• tuberous sclerosis complex

OBJECT Tuberous sclerosis complex (TSC) with medically refractory epilepsy is characterized by multifocal brain abnormalities, traditionally indicating poor surgical candidacy. This single-center, retrospective study appraised seizure-related, neuropsychological, and other outcomes of resective surgery in TSC patients with medically refractory epilepsy, and analyzed predictors for these outcomes.
METHODS Patients with multilesional TSC who underwent epilepsy surgery between 2007 and 2012 were identified from an electronic database. All patients underwent multimodality noninvasive and subsequent invasive evaluation. Seizure outcomes were classified using the International League Against Epilepsy (ILAE) scale. The primary outcome measure was complete seizure remission (ILAE Class 1). Secondary outcome measures included 50% responder rate, change in full-scale IQ, electroencephalography improvement, and reduction in antiepileptic drug (AED) burden.
RESULTS A total of 37 patients with TSC underwent resective surgery during the study. period. After a mean follow-up of 5.68 +/- 3.67 years, 56.8% achieved complete seizure freedom (ILAE Class 1) and 86.5% had ILAE Class 4 outcomes or better. The full-scale IQ on follow-up was significantly higher in patients with ILAE Class 1 outcome (66.70 +/- 12.36) compared with those with ILAE Class 2 or worse outcomes (56.00 +/- 1.41, p = 0.025). In 62.5% of the patients with ILAE Class 2 or worse outcomes, the number of AEDs were found to be significantly reduced (p = 0.004).
CONCLUSIONS This study substantiates the evidence for efficacy of resective epilepsy surgery in patients with bilateral multilesional TSC. More than half of the patients were completely seizure free. Additionally, a high proportion achieved clinically meaningful reduction in seizure burden and the number of AEDs.

• 出版日期2015-1