title: Resective Epilepsy Surgery for Tuberous Sclerosis in Children: Determining Predictors of Seizure Outcomes in a Multicenter Retrospective Cohort Study.
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.
  
  
  CONCLUSIONS
  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.affiliation: *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.
authors.forename: Aria
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mesh_terms: D000293:Adolescent; D002540:Cerebral Cortex / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D000069279:Drug Resistant Epilepsy / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D004569:Electroencephalography / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014402:Tuberous Sclerosis / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*