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Interictal Discharge Pattern in Preschool-Aged Children With Tuberous Sclerosis Complex Before and After Resective
Liu Yuan1,2, Yangshuo Wang1, Shuhua Cheng3
1Functional Neurosurgery Department, National Children's Health Center of China, Beijing Children's Hospital, Capital Medical University, Beijing, China.
Insights
Resective surgery for tuberous sclerosis complex (TSC) epilepsy can normalize scalp electroencephalogram (EEG) patterns in over a third of children. Post-operative seizure freedom correlates with normal or focal interictal discharge (IID) patterns on EEG.
Area of Science:
- Pediatric Neurology
- Epileptology
- Neurophysiology
Background:
- Tuberous sclerosis complex (TSC) is a genetic disorder associated with epilepsy.
- Epileptogenic tubers are a common cause of intractable epilepsy in TSC.
- Pre-operative electroencephalogram (EEG) findings, including interictal discharges (IIDs), are important for surgical planning.
Purpose of the Study:
- To analyze interictal discharge (IID) patterns on pre-operative scalp EEG.
- To compare changes in IID patterns after surgical removal of epileptogenic tubers.
- To evaluate the correlation between IID patterns and seizure outcomes in preschool children with TSC-related epilepsy.
Main Methods:
- Retrospective analysis of EEG data from 35 preschool children with TSC who underwent resective surgery.
- EEG data collected pre-operatively and up to 3 years post-operatively.
- Comparison of IID patterns and seizure control rates.
Main Results:
- 65.7% of patients were seizure-free at 1-year follow-up.
- 37-40% of post-operative patients showed normal scalp EEGs (non-IID).
- Pre-operative IID patterns did not predict seizure control, but post-operative non-IID and focal IIDs were associated with seizure freedom.
- New focal IIDs post-operatively significantly decreased seizure freedom at 3-year follow-up.
Conclusions:
- Over one-third of children with TSC achieve normal scalp EEGs after resective epilepsy surgery.
- Post-operative seizure freedom is more likely in patients with non-IID or focal IID patterns on post-operative EEGs.
- The emergence of new focal IIDs post-operatively is a negative predictor for long-term seizure freedom.
Objective:
To analyze the interictal discharge (IID) patterns on pre-operative scalp electroencephalogram (EEG) and compare the changes in IID patterns after removal of epileptogenic tubers in preschool children with tuberous sclerosis complex (TSC)-related epilepsy.
Methods:
Thirty-five preschool children who underwent resective surgery for TSC-related epilepsy were enrolled retrospectively, and their EEG data collected before surgery to 3 years after surgery were analyzed.
Results:
Twenty-three (65.7%) patients were seizure-free post-operatively at 1-year follow-up, and 37-40% of post-operative patients rendered non-IID on scalp EEGs, and patients with focal IIDs or generalized IID patterns on pre-operative EEG presented a high percentage of normal post-operative scalp EEGs. IID patterns on pre-operative scalp EEGs did not influence the outcomes of post-operative seizure controls, while patients with non-IID and focal IID on post-operative EEGs were likely to achieve post-operative seizure freedom. Patients with new focal IIDs presented a significantly lower percentage of seizure freedom than those without new focal IIDs on post-operative EEGs at 3-year follow-up.
Conclusion:
Over 1/3 children with TSC presented normal scalp EEGs after resective epileptsy surgery. Patients with post-operative seizure freedom were more likely to have non-IIDs on post-operative EEGs. New focal IIDs were negative factors for seizure freedom at the 3-year follow-up.
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