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

Area of Science:

• Neurology
• Neurosurgery
• Genetics

Background:

• Epilepsy surgery outcomes in Tuberous Sclerosis Complex (TSC) are primarily known from small tertiary care center series.
• Generalizability of these findings to the broader epilepsy surgery community remains unclear.

Purpose of the Study:

• To evaluate epilepsy surgery outcomes in a large, real-world cohort of patients with TSC in the United States.
• To compare resective epilepsy surgery outcomes with palliative corpus callosotomy (CC).

Main Methods:

• Data from 2059 patients with TSC were analyzed from the National TSC Natural History Database (TSCNHD).
• Surgical procedures included tuberectomy/sublobar resection and lobectomy/multilobar resection, compared against CC.
• Proportional odds logistic regression and Poisson regression analyses were employed.

Main Results:

• Of 229 patients undergoing epilepsy surgery, common procedures were tuberectomy/sublobar resection (44%) and lobectomy/multilobar resection (40%).
• Use of advanced imaging like PET, SPECT, and MEG was low (20-29%).
• Good seizure outcomes were observed in 41% of patients, with resective surgeries showing significantly better outcomes (OR 11.58 for tuberectomy, OR 5.99 for lobectomy) compared to CC.

Conclusions:

• Epilepsy surgery in TSC in the US frequently omits advanced imaging modalities.
• Real-world seizure outcomes were lower than previously reported from specialized centers.
• Single tuber and lobar/multilobar resections were associated with the best seizure outcomes and higher likelihood of antiseizure medication reduction.