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Long-term outcomes of epilepsy surgery in tuberous sclerosis complex

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Abstract

Approximately 50% of patients with tuberous sclerosis complex (TSC) present intractable epilepsy, and surgery is an option for those patients. Hereby, we analyze long-term seizure control and neuropsychological outcomes of epilepsy surgery in patients with TSC. Clinical data were retrospectively collected from 66 patients with TSC and epilepsy followed up over 5 years, 51 of whom underwent epilepsy surgery between 2001 and 2011. Reductions in the number of seizures were analyzed at 1-year (1FU), 5-year (5FU), and 10-year (10FU) follow-ups visits after the operation. Influential factors on postoperative seizure free and intelligence quotient (IQ) and quality-of-life (QOL) outcomes were evaluated at 5FU. Resective procedures included 26 tuber resections, 15 lobectomies, and 10 tuber resections and lobectomies. Corpus callosotomies were performed as the adjunctive approach in 11 cases with low IQ. The percentages of seizure-free cases were 74.5% at 1FU, 58.8% at 5FU, and 47.8% at 10FU, and the predictive factor for long-term postoperative seizure freedom was the history of preoperative seizures and preoperative full-scale IQ. Significant improvements were found in performance IQ, full-scale IQ, and QOL in patients from the surgery group, particularly those who were seizure free after the operation. Our study showed that epilepsy surgery in TSC with epilepsy rendered improvements in seizure control, full-scale IQ, and QOL. Satisfactory long-term seizure control was often achieved with an early operation and without mental retardation, and improvements in QOL and IQ were frequently observed in postoperative patients who remained seizure free.

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Acknowledgements

The authors would like to show gratitude to the patients and their families for their long-term cooperation, Prof. J. F. Yang for MRI image interpretation, and Prof. Q. H. Ouyang for PET image interpretation. We also appreciate the contribution provided by the following people: Dr. C. Gao, and Dr. H. B. Kong from Neurosurgery Department, and Dr. S. S. Liang, Mrs. X. M. Yu, and all technicians in the Neurophysiologic Laboratory of Capital Epilepsy Therapy Center.

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Authors and Affiliations

  1. Department of Neurosurgery, General Hospital of PLA, Beijing, China

    Shuli Liang, Zhiqiang Cui & Ping Ding

  2. Department of Neurosurgery, First Affiliated Hospital of General Hospital of PLA, Beijing, China

    Shuli Liang, Shaohui Zhang, Jianfei Cui, Jiwu Zhang, Na Liu & Ping Ding

  3. Department of Neurosurgery, Affiliated Hospital of Jining Medical College, Jining, China

    Juncheng Zhang

  4. Pediatrics, First Affiliated Hospital of Peking University, Beijing, China

    Zhixian Yang

  5. Department of Neurosurgery, Heze Xincheng Hospital, Heze, China

    Jiwu Zhang

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  1. Shuli Liang
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  2. Juncheng Zhang
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  3. Zhixian Yang
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  4. Shaohui Zhang
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  5. Zhiqiang Cui
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  9. Ping Ding
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Correspondence to Shuli Liang.

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Liang, S., Zhang, J., Yang, Z. et al. Long-term outcomes of epilepsy surgery in tuberous sclerosis complex. J Neurol 264, 1146–1154 (2017). https://doi.org/10.1007/s00415-017-8507-y

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  • DOI: https://doi.org/10.1007/s00415-017-8507-y

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