Epilepsy Surgery in Tuberous Sclerosis Complex: A TSC Natural History Database Study

Only small series from tertiary care centers inform us on epilepsy surgery in tuberous sclerosis complex (TSC). The generalizability of these results to the wider epilepsy surgery community is unclear.

Epilepsy surgery data were collected from the National TSC Natural History Database (TSCNHD). Resective outcomes were also compared with a palliative procedure, namely, corpus callosotomy (CC). Proportional odds logistic regression and Poisson regression analyses were used.

Of 2059 patients, 229 (13%) had epilepsy surgery at mean age 7.3 years. Common surgeries included tuberectomy/sublobar resection (44%) and lobectomy/multilobar resection (40%). Use of positron emission tomography (PET) (24%), single-photon emission computed tomography (SPECT) (20%), and magnetoencephalography (MEG) (29%) was low. Invasive long-term video electroencephalography was used in 29%. At mean follow-up of 6.8 years, good outcomes were noted in 56 (41%), moderate in 33 (24%), and poor in 49 (35%) patients. Compared with CC, tuberectomy/sublobar resection (odds ratio [OR], 11.58) and lobectomy/multilobar resection (OR, 5.99) were associated with good outcomes. When compared with CC, most antiseizure medication (ASM) reduction occurred in patients after tuberectomy/sublobar resection (P = 0.040).

Most TSC epilepsy surgeries in the United States were performed without use of PET, SPECT, or MEG. Lower rates of "good" seizure outcomes were observed in this real-world study when compared with previously published outcomes from tertiary care epilepsy centers. Best seizure outcomes were reported after a single tuber and lobar/multilobar resection with a high likelihood of ASM reduction on follow-up. TSCNHD provides a proof of concept in studying surgery outcomes in rare genetic diseases.