For children with tuberous sclerosis complex (TSC), more extensive resective epilepsy surgery may be more effective in reducing seizures.
Aria Fallah, MD, MSc, of Miami Children’s Hospital, and colleagues conducted a restrospective chart review of 74 children (median age 120 months; median seizure recurrence 24 months) with TSC who underwent epilepsy surgery. While TSC is rare, it is one of the most common genetic causes of epilepsy. The non-malignant tumors associated with TSC can also cause patients to develop intellectual and developmental disabilities and autism.
Engel Class I outcome was achieved in 48 patients (65%) at one-year follow-up and 37 (50%) at two-year follow-up. However, the researchers found that patients with younger age at seizure onset, larger predominant tuber size, and larger resection (more than a tuberectomy) were more likely to experience a longer duration of seizure freedom. After adjustment for other factors, resection larger than a tuberectomy remained the only statistically significant factor independently associated with a longer period of seizure freedom.
Patients who underwent both tuberectomy and lobectomy were nearly three times more likely to remain seizure-free for a longer period of time compared to those only undergoing tuberectomy.
“This suggests that the epileptogenic zone may include the cortex surrounding the presumed offending tuber,” Fallah and colleagues wrote, suggesting that the role of tuberectomies may be limited when it comes to sustained seizure freedom in TSC.
The researchers stressed that more research needs to be conducted to clarify the factors associated with better or worse outcomes of epilepsy surgery in TSC, and criteria needs to be standardized in order to better determine children eligible for the surgical procedure.