title: Long-term outcomes of resective epilepsy surgery after invasive presurgical evaluation in children with tuberous sclerosis complex and bilateral multiple lesions.
abstract: OBJECTIVE
  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 seizurerelated, 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.
authors.affiliation: Divisions of Neurology.
authors.forename: Ravindra
authors.initials: R
authors.lastname: Arya
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Tenney
authors.forename: Paul S
authors.initials: PS
authors.lastname: Horn
authors.forename: Hansel M
authors.initials: HM
authors.lastname: Greiner
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Holland
authors.forename: James L
authors.initials: JL
authors.lastname: Leach
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gelfand
authors.forename: Leonid
authors.initials: L
authors.lastname: Rozhkov
authors.forename: Hisako
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Rose
authors.forename: David N
authors.initials: DN
authors.lastname: Franz
authors.forename: Francesco T
authors.initials: FT
authors.lastname: Mangano
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology* / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D057286:Electronic Health Records; D004827:Epilepsy / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014402:Tuberous Sclerosis / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology
keywords: AED = antiepileptic drug; ECD = equivalent current dipole; ECoG = electrocorticography; EEG = electroencephalography; FSIQ = full-scale IQ; ILAE = International League Against Epilepsy; IQR = interquartile range; MEG = magnetoencephalography; SPM = statistical parametric mapping; TSC = tuberous sclerosis complex; epilepsy surgery; medically refractory epilepsy; tuberous sclerosis complex