Predictors of seizure-free outcome after epilepsy surgery for pediatric tuberous sclerosis complex

Pavel Krsek, Alena Jahodova, Martin Kyncl, Martin Kudr, Vladimir Komarek, Petr Jezdik, Prasanna Jayakar, Ian Miller, Brandon Korman, Gustavo Rey, Trevor Resnick, Michael Duchowny

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Purpose Variable predictors of postsurgical seizure outcome have been reported in children with tuberous sclerosis complex (TSC). We analyzed a large surgical series of pediatric TSC patients in order to identify prognostic factors crucial for selection of subjects for epilepsy surgery. Methods Thirty-three children with TSC who underwent excisional epilepsy surgery at Miami Children's Hospital were retrospectively reviewed. A total of 29 clinical, neuropsychological, electroencephalography (EEG), magnetic resonance imaging (MRI), and surgical variables were analyzed and related to seizure outcomes. Univariate Barnard's exact test, Wilcoxon's rank-sum test, and multivariate statistical Cox's model were used to examine the significance of associations between the variables and seizure outcome. Key Findings Eighteen patients (55%) have been seizure-free 2 years after (final) surgery; postoperative complications occurred in five subjects (15%). Complete removal of epileptogenic tissue detected by both MRI and intracranial EEG, regional scalp interictal EEG patterns, and agreement of interictal and ictal EEG localization were the most powerful predictors of seizure-free outcome. Other significant predictors included occurrence of regional scalp ictal EEG patterns, fewer brain regions affected by tubers, presence of preoperative hemiparesis, and one-stage surgery. Remaining factors such as age at seizure onset, incidence of infantile spasms or other seizure types, duration of epilepsy, seizure frequency, mental retardation, as well as types and extent of resections did not influence outcome. Significance Perioperative features rather than preoperative variables are the most important determinants of postsurgical seizure outcome in patients with TSC. Our findings may assist in the surgical management of these patients.

Original languageEnglish
Pages (from-to)1913-1921
Number of pages9
JournalEpilepsia
Volume54
Issue number11
DOIs
StatePublished - Nov 1 2013

Fingerprint

Tuberous Sclerosis
Epilepsy
Seizures
Pediatrics
Electroencephalography
Nonparametric Statistics
Scalp
Stroke
Magnetic Resonance Imaging
Infantile Spasms
Statistical Models
Paresis
Age of Onset
Proportional Hazards Models
Intellectual Disability
Patient Selection
Incidence
Brain

Keywords

  • Completeness of resection
  • EEG
  • Epilepsy surgery
  • Seizure outcome
  • Tuberous sclerosis complex

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Krsek, P., Jahodova, A., Kyncl, M., Kudr, M., Komarek, V., Jezdik, P., ... Duchowny, M. (2013). Predictors of seizure-free outcome after epilepsy surgery for pediatric tuberous sclerosis complex. Epilepsia, 54(11), 1913-1921. https://doi.org/10.1111/epi.12371

Predictors of seizure-free outcome after epilepsy surgery for pediatric tuberous sclerosis complex. / Krsek, Pavel; Jahodova, Alena; Kyncl, Martin; Kudr, Martin; Komarek, Vladimir; Jezdik, Petr; Jayakar, Prasanna; Miller, Ian; Korman, Brandon; Rey, Gustavo; Resnick, Trevor; Duchowny, Michael.

In: Epilepsia, Vol. 54, No. 11, 01.11.2013, p. 1913-1921.

Research output: Contribution to journalArticle

Krsek, P, Jahodova, A, Kyncl, M, Kudr, M, Komarek, V, Jezdik, P, Jayakar, P, Miller, I, Korman, B, Rey, G, Resnick, T & Duchowny, M 2013, 'Predictors of seizure-free outcome after epilepsy surgery for pediatric tuberous sclerosis complex', Epilepsia, vol. 54, no. 11, pp. 1913-1921. https://doi.org/10.1111/epi.12371
Krsek P, Jahodova A, Kyncl M, Kudr M, Komarek V, Jezdik P et al. Predictors of seizure-free outcome after epilepsy surgery for pediatric tuberous sclerosis complex. Epilepsia. 2013 Nov 1;54(11):1913-1921. https://doi.org/10.1111/epi.12371
Krsek, Pavel ; Jahodova, Alena ; Kyncl, Martin ; Kudr, Martin ; Komarek, Vladimir ; Jezdik, Petr ; Jayakar, Prasanna ; Miller, Ian ; Korman, Brandon ; Rey, Gustavo ; Resnick, Trevor ; Duchowny, Michael. / Predictors of seizure-free outcome after epilepsy surgery for pediatric tuberous sclerosis complex. In: Epilepsia. 2013 ; Vol. 54, No. 11. pp. 1913-1921.
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abstract = "Purpose Variable predictors of postsurgical seizure outcome have been reported in children with tuberous sclerosis complex (TSC). We analyzed a large surgical series of pediatric TSC patients in order to identify prognostic factors crucial for selection of subjects for epilepsy surgery. Methods Thirty-three children with TSC who underwent excisional epilepsy surgery at Miami Children's Hospital were retrospectively reviewed. A total of 29 clinical, neuropsychological, electroencephalography (EEG), magnetic resonance imaging (MRI), and surgical variables were analyzed and related to seizure outcomes. Univariate Barnard's exact test, Wilcoxon's rank-sum test, and multivariate statistical Cox's model were used to examine the significance of associations between the variables and seizure outcome. Key Findings Eighteen patients (55{\%}) have been seizure-free 2 years after (final) surgery; postoperative complications occurred in five subjects (15{\%}). Complete removal of epileptogenic tissue detected by both MRI and intracranial EEG, regional scalp interictal EEG patterns, and agreement of interictal and ictal EEG localization were the most powerful predictors of seizure-free outcome. Other significant predictors included occurrence of regional scalp ictal EEG patterns, fewer brain regions affected by tubers, presence of preoperative hemiparesis, and one-stage surgery. Remaining factors such as age at seizure onset, incidence of infantile spasms or other seizure types, duration of epilepsy, seizure frequency, mental retardation, as well as types and extent of resections did not influence outcome. Significance Perioperative features rather than preoperative variables are the most important determinants of postsurgical seizure outcome in patients with TSC. Our findings may assist in the surgical management of these patients.",
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N2 - Purpose Variable predictors of postsurgical seizure outcome have been reported in children with tuberous sclerosis complex (TSC). We analyzed a large surgical series of pediatric TSC patients in order to identify prognostic factors crucial for selection of subjects for epilepsy surgery. Methods Thirty-three children with TSC who underwent excisional epilepsy surgery at Miami Children's Hospital were retrospectively reviewed. A total of 29 clinical, neuropsychological, electroencephalography (EEG), magnetic resonance imaging (MRI), and surgical variables were analyzed and related to seizure outcomes. Univariate Barnard's exact test, Wilcoxon's rank-sum test, and multivariate statistical Cox's model were used to examine the significance of associations between the variables and seizure outcome. Key Findings Eighteen patients (55%) have been seizure-free 2 years after (final) surgery; postoperative complications occurred in five subjects (15%). Complete removal of epileptogenic tissue detected by both MRI and intracranial EEG, regional scalp interictal EEG patterns, and agreement of interictal and ictal EEG localization were the most powerful predictors of seizure-free outcome. Other significant predictors included occurrence of regional scalp ictal EEG patterns, fewer brain regions affected by tubers, presence of preoperative hemiparesis, and one-stage surgery. Remaining factors such as age at seizure onset, incidence of infantile spasms or other seizure types, duration of epilepsy, seizure frequency, mental retardation, as well as types and extent of resections did not influence outcome. Significance Perioperative features rather than preoperative variables are the most important determinants of postsurgical seizure outcome in patients with TSC. Our findings may assist in the surgical management of these patients.

AB - Purpose Variable predictors of postsurgical seizure outcome have been reported in children with tuberous sclerosis complex (TSC). We analyzed a large surgical series of pediatric TSC patients in order to identify prognostic factors crucial for selection of subjects for epilepsy surgery. Methods Thirty-three children with TSC who underwent excisional epilepsy surgery at Miami Children's Hospital were retrospectively reviewed. A total of 29 clinical, neuropsychological, electroencephalography (EEG), magnetic resonance imaging (MRI), and surgical variables were analyzed and related to seizure outcomes. Univariate Barnard's exact test, Wilcoxon's rank-sum test, and multivariate statistical Cox's model were used to examine the significance of associations between the variables and seizure outcome. Key Findings Eighteen patients (55%) have been seizure-free 2 years after (final) surgery; postoperative complications occurred in five subjects (15%). Complete removal of epileptogenic tissue detected by both MRI and intracranial EEG, regional scalp interictal EEG patterns, and agreement of interictal and ictal EEG localization were the most powerful predictors of seizure-free outcome. Other significant predictors included occurrence of regional scalp ictal EEG patterns, fewer brain regions affected by tubers, presence of preoperative hemiparesis, and one-stage surgery. Remaining factors such as age at seizure onset, incidence of infantile spasms or other seizure types, duration of epilepsy, seizure frequency, mental retardation, as well as types and extent of resections did not influence outcome. Significance Perioperative features rather than preoperative variables are the most important determinants of postsurgical seizure outcome in patients with TSC. Our findings may assist in the surgical management of these patients.

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