Aria Fallah1, Shaun D Rodgers, Alexander G Weil, Sumeet Vadera, 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 Snead, James T Rutka. 1. *Department of Neurosurgery, Miami Children's Hospital, Miami, Florida; ‡Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; §Department of Neurosurgery, New York University Langone Medical Center, New York, New York; ¶Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio; ‖Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; #Division of Neurology, BC Children's Hospital, Vancouver, BC, Canada; **Division of Neurology, CHU Sainte-Justine, Montreal, QC, Canada; ‡‡Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania; §§Department of Neurology, New York University Langone Medical Center, New York, New York; ¶¶Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio; ‖‖Division of Neurosurgery, BC Children's Hospital, Vancouver, BC, Canada; ##Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada; ***Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.
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.
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.
Authors: Shaun A Hussain; Gary W Mathern; Phoebe Hung; Julius Weng; Raman Sankar; Joyce Y Wu Journal: Epilepsy Res Date: 2017-06-16 Impact factor: 3.045
Authors: H Alexander; R B Govindan; T Anwar; V C Chirumamilla; I Fayed; R F Keating; W D Gaillard; C O Oluigbo Journal: Childs Nerv Syst Date: 2021-08-29 Impact factor: 1.475
Authors: Leslie E Grayson; Jurriaan M Peters; Tarrant McPherson; Darcy A Krueger; Mustafa Sahin; Joyce Y Wu; Hope A Northrup; Brenda Porter; Gary R Cutter; Sarah E O'Kelley; Jessica Krefting; Scellig S Stone; Joseph R Madsen; Aria Fallah; Jeffrey P Blount; Howard L Weiner; E Martina Bebin Journal: Pediatr Neurol Date: 2020-04-14 Impact factor: 3.372
Authors: Rima Nabbout; Elena Belousova; Mirjana P Benedik; Tom Carter; Vincent Cottin; Paolo Curatolo; Maria Dahlin; Lisa D Amato; Guillaume Beaure d'Augères; Petrus J de Vries; José C Ferreira; Martha Feucht; Carla Fladrowski; Christoph Hertzberg; Sergiusz Jozwiak; John A Lawson; Alfons Macaya; Ruben Marques; Finbar O'Callaghan; Jiong Qin; Valentin Sander; Matthias Sauter; Seema Shah; Yukitoshi Takahashi; Renaud Touraine; Sotiris Youroukos; Bernard Zonnenberg; Anna Jansen; John C Kingswood Journal: Epilepsia Open Date: 2018-12-21