Pathways to epilepsy surgery in children with tuberous sclerosis complex-associated epilepsy

Area of Science:

• Neurology
• Pediatric Epilepsy
• Tuberous Sclerosis Complex

Background:

• Epilepsy surgery efficacy is known in select children with tuberous sclerosis complex (TSC).
• Patient selection and characteristics for TSC-related epilepsy surgery remain underdescribed.
• This study details the pathways to epilepsy surgery in children with TSC over 20 years.

Purpose of the Study:

• To describe patient selection and characteristics for epilepsy surgery in children with TSC.
• To analyze surgical outcomes and compare them with non-surgical management.
• To identify factors influencing surgical success in this population.

Main Methods:

• Retrospective cohort study of 84 children with TSC and epilepsy from two French centers.
• Data collected included demographics, clinical history, and surgical procedures.
• Included registry matching and medical record reviews.

Main Results:

• 19% of children underwent resective surgery, often before age four; 44% had stereotactic electroencephalography.
• Seizure freedom was achieved in 57% at 1 year and 43% at 10 years post-surgery.
• 52% of non-operated drug-resistant patients became seizure-free; 50% of operated patients reduced anti-seizure medications.

Conclusions:

• Epilepsy surgery in children with TSC yields results comparable to other drug-resistant epilepsy populations.
• Conditions like infantile spasms or developmental disorders are not absolute contraindications but may lower seizure freedom rates.
• Non-operated patients may experience spontaneous evolution to drug-sensitive epilepsy.