title: Resection of ictal high frequency oscillations is associated with favorable surgical outcome in pediatric drug resistant epilepsy secondary to tuberous sclerosis complex.
abstract: Resective epilepsy surgery can improve seizures when the epileptogenic zone (EZ) is limited to a well-defined region. High frequency oscillations (HFO) have been recognized as having a high association with the seizure onset zone. Therefore, we retrospectively identified ictal HFOs and determined their relationship to specific intracranial features of cortical tubers in children with TSC who underwent resective surgery. We identified 14 patients with drug resistant epilepsy secondary to TSC who underwent subdural grid and strip implantation for presurgical evaluation and subsequent resection with adequate post-surgical follow-up. We aimed to determine the relationship between ictal HFOs, post-resection outcome and neuroimaging features in this population. The largest tuber was identified in all 14 patients (100%). Four patients (29%) had unusual tubers. HFOs were observed at ictal onset in all 14 patients. Seven of 10 patients with complete resection of HFOs were seizure free. The better seizure outcome (ILAE=1-3) was achieved with complete HFO resection regardless of the unique TSC structural features (p=0.0140). Our study demonstrates the presence of ripple and fast ripple range HFOs at ictal onset in children with TSC. Our study showed that complete HFO resection led to the better surgical outcome, independent of MR imaging findings.
authors.affiliation: Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. Electronic address: Hisako.fujiwara@cchmc.org.
authors.forename: Hisako
authors.initials: H
authors.lastname: Fujiwara
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. Electronic address: James.Leach@cchmc.org.
authors.forename: James L
authors.initials: JL
authors.lastname: Leach
authors.affiliation: Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. Electronic address: Hansel.Greiner@cchmc.org.
authors.forename: Hansel M
authors.initials: HM
authors.lastname: Greiner
authors.affiliation: Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. Electronic address: Katherine.Holland@cchmc.org.
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Holland-Bouley
authors.affiliation: Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. Electronic address: Douglas.Rose@cchmc.org.
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Rose
authors.affiliation: Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. Electronic address: Todd.Arthur@cchmc.org.
authors.forename: Todd
authors.initials: T
authors.lastname: Arthur
authors.affiliation: Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. Electronic address: Francesco.Mangano@cchmc.org.
authors.forename: Francesco T
authors.initials: FT
authors.lastname: Mangano
mesh_terms: D000293:Adolescent; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D000069279:Drug Resistant Epilepsy / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D000069280:Electrocorticography; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012640:Seizures / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome; D014402:Tuberous Sclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*
keywords: High frequency oscillations (HFOs); Intracranial EEG (ICEEG); Surgical outcome; Tuberous sclerosis complex (TSC)