Resective Surgery for Drug-Resistant Epilepsy in Patients With Tuberous Sclerosis Complex: A Prospective Nationwide...

Area of Science:

• Neurology
• Neurosurgery
• Genetics

Background:

• Tuberous Sclerosis Complex (TSC) often causes drug-resistant epilepsy (DRE).
• Resective surgery is a potential treatment, but high-level evidence is limited.
• Prospective multicenter data are needed to compare surgery with medication.

Purpose of the Study:

• To compare the effectiveness and safety of resective surgery versus continued medication for TSC-related DRE.
• To provide prospective multicenter data on surgical outcomes.

Main Methods:

• Prospective cohort study of 200 TSC-DRE patients (21 centers, China, 2019-2022).
• Patients underwent resective surgery or continued medication.
• Follow-up ≥2 years assessing seizure control, IQ, QOL, ASMs, and adverse events.
• Propensity score matching (PSM) and survival analysis (Kaplan-Meier, Cox models) were used.

Main Results:

• PSM-adjusted 1-year seizure-freedom rate was 77% in the surgery group vs. 13% in the medicine group.
• Resective surgery was the strongest predictor of reduced seizure recurrence (HR 0.10, p < 0.0001).
• Significant improvements in IQ and QOL were observed at 2 years post-surgery, with reduced ASMs and no increase in serious adverse events.

Conclusions:

• Resective surgery is significantly more effective than medication for seizure control, IQ, and QOL in TSC-DRE.
• The safety profile of resective surgery is comparable to medication.
• Outstanding tubers on MRI predict better postoperative seizure freedom.