Predictors of seizure-free outcome after epilepsy surgery for pediatric tuberous sclerosis complex

Authors

  • Pavel Krsek,

    1. Department of Pediatric Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
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  • Alena Jahodova,

    1. Department of Pediatric Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
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  • Martin Kyncl,

    1. Department of Radiology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
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  • Martin Kudr,

    1. Department of Pediatric Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
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  • Vladimir Komarek,

    1. Department of Pediatric Neurology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
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  • Petr Jezdik,

    1. Department of Measurement, Faculty of Electric, Czech Technical University Prague, Prague, Czech Republic
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  • Prasanna Jayakar,

    1. Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Miami Children's Hospital, Miami, Florida, U.S.A
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  • Ian Miller,

    1. Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Miami Children's Hospital, Miami, Florida, U.S.A
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  • Brandon Korman,

    1. Neuropsychology Section, Brain Institute and Behavioral Medicine, Miami Children's Hospital, Miami, Florida, U.S.A
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  • Gustavo Rey,

    1. Neuropsychology Section, Brain Institute and Behavioral Medicine, Miami Children's Hospital, Miami, Florida, U.S.A
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  • Trevor Resnick,

    1. Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Miami Children's Hospital, Miami, Florida, U.S.A
    2. Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
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  • Michael Duchowny

    Corresponding author
    1. Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Miami Children's Hospital, Miami, Florida, U.S.A
    2. Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
    • Address correspondence to Michael Duchowny, Department of Neurology, Brain Institute, Miami Children's Hospital, University of Miami Miller School of Medicine, 3200 S.W. 60th Court, Miami, FL, U.S.A. E-mail: michael.duchowny@mch.com

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Summary

Purpose

Variable predictors of postsurgical seizure outcome have been reported in children with tuberous sclerosis complex (TSC). We analyzed a large surgical series of pediatric TSC patients in order to identify prognostic factors crucial for selection of subjects for epilepsy surgery.

Methods

Thirty-three children with TSC who underwent excisional epilepsy surgery at Miami Children's Hospital were retrospectively reviewed. A total of 29 clinical, neuropsychological, electroencephalography (EEG), magnetic resonance imaging (MRI), and surgical variables were analyzed and related to seizure outcomes. Univariate Barnard's exact test, Wilcoxon's rank-sum test, and multivariate statistical Cox's model were used to examine the significance of associations between the variables and seizure outcome.

Key Findings

Eighteen patients (55%) have been seizure-free 2 years after (final) surgery; postoperative complications occurred in five subjects (15%). Complete removal of epileptogenic tissue detected by both MRI and intracranial EEG, regional scalp interictal EEG patterns, and agreement of interictal and ictal EEG localization were the most powerful predictors of seizure-free outcome. Other significant predictors included occurrence of regional scalp ictal EEG patterns, fewer brain regions affected by tubers, presence of preoperative hemiparesis, and one-stage surgery. Remaining factors such as age at seizure onset, incidence of infantile spasms or other seizure types, duration of epilepsy, seizure frequency, mental retardation, as well as types and extent of resections did not influence outcome.

Significance

Perioperative features rather than preoperative variables are the most important determinants of postsurgical seizure outcome in patients with TSC. Our findings may assist in the surgical management of these patients.

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