Resective epilepsy surgery in tuberous sclerosis complex: a nationwide multicentre retrospective study from China.,Brain

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Resective epilepsy surgery in tuberous sclerosis complex: a nationwide multicentre retrospective study from China.
Brain ( IF 14.5 ) Pub Date : 2020-01-18 , DOI: 10.1093/brain/awz411
Shiyong Liu ₁ , Tao Yu ₂ , Yuguang Guan ₃ , Kai Zhang ₄ , Ping Ding ₅ , Lei Chen ₆ , Yongzhi Shan ₇ , Qiang Guo ₈ , Qingzhu Liu ₉ , Yi Yao ₁₀ , Meihua Yang ₁ , Shaohui Zhang ₅ , Yuanxiang Lin ₁₁ , Rui Zhao ₁₂ , Zhiqi Mao ₁₃ , Juncheng Zhang ₁₄ , Chunqing Zhang ₁ , Rui Zhang ₁₅ , Zhiquan Yang ₁₆ , Ruobing Qian ₁₇ , Yunlin Li ₁₈ , Guangming Zhang ₁₉ , Liu Yuan ₅ , Weidong Yang ₂₀ , Hong Tian ₂₁ , Hua Zhang ₂₂ , Wenling Li ₂₃ , Xinwei Zhang ₂₄ , Jian Yin ₂₅ , Yanwu Guo ₂₆ , Liping Zou ₂₇ , Jiong Qin ₂₈ , Fang Fang ₂₉ , Xu Wang ₂₉ , Ming Ge ₃₀ , Shuli Liang ₃₁

Affiliation

Department of Neurosurgery, Xinqiao Hospital, Army Military Medical University, Chongqing, China.
Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Fourth Medical Center of PLA General Hospital, Beijing, China.
Department of Neurology, Western China Hospital, Sichuan University, Chengdu, China.
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Guangdong Sanjiu Brain Hospital, Guangzhou, China.
Pediatric Epilepsy Surgery Center, First Affiliated Hospital of Peking University, Beijing, China.
Department of Neurosurgery, Xiamen Hongai Hospital, Xiamen, China.
Department of Neurosurgery, First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
Department of Neurosurgery, Children Hospital, Fudan University, Shanghai, China.
Department of Neurosurgery, First Medical Center of PLA General Hospital, Beijing, China.
Department of Neurosurgery, Affiliated Hospital of Jining Medical College, Jining, China.
Department of Functional Neurosurgery, Brain Hospital, Nanjing Medical University, Nanjing, China.
Department of Neurosurgery, Xiangya Hospital, Central Southern University, Changsha, China.
Department of Neurosurgery, First Affiliated Hospital, University of Science and Technology of China, Hefei, China.
Department of Neurosurgery, Children Hospital, Capital Institute of Pediatrics, Beijing, China.
Department of Neurosurgery, Beijing Aviation General Hospital, Beijing, China.
Department of Neurosurgery, General Hospital, Tianjin Medical University, Tianjin, China.
Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China.
Department of Neurosurgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
Department of Neurosurgery, Second Affiliated Hospital, Hebei Medical University, Shijiazhuang, China.
Department of Neurosurgery, Third Affiliated Hospital, Southern Medical University, Guangzhou, China.
Department of Neurosurgery, Second Affiliated Hospital, Dalian Medical University, Dalian, China.
Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Pediatrics Department, First Medical Center of PLA General Hospital, Beijing, China.
Pediatrics Department, Beijing People's Hospital, Peking University, Beijing, China.
Neurology Department, Beijing Children's Hospital, Capital Medical University, Beijing, China.
Neurosurgery Department, Beijing Children's Hospital, Capital Medical University, Beijing, China.
Functional Neurosurgery Department, Beijing Children's Hospital, Capital Medical University, Beijing, China.

At least 50% of patients with tuberous sclerosis complex present with intractable epilepsy; for these patients, resective surgery is a treatment option. Here, we report a nationwide multicentre retrospective study and analyse the long-term seizure and neuropsychological outcomes of epilepsy surgery in patients with tuberous sclerosis complex. There were 364 patients who underwent epilepsy surgery in the study. Patients' clinical data, postoperative seizure outcomes at 1-, 4-, and 10-year follow-ups, preoperative and postoperative intelligence quotients, and quality of life at 1-year follow-up were collected. The patients' ages at surgery were 10.35 ± 7.70 years (range: 0.5-47). The percentage of postoperative seizure freedom was 71% (258/364) at 1-year, 60% (118/196) at 4-year, and 51% (36/71) at 10-year follow-up. Influence factors of postoperative seizure freedom were the total removal of epileptogenic tubers and the presence of outstanding tuber on MRI at 1- and 4-year follow-ups. Furthermore, monthly seizure (versus daily seizure) was also a positive influence factor for postoperative seizure freedom at 1-year follow-up. The presence of an outstanding tuber on MRI was the only factor influencing seizure freedom at 10-year follow-up. Postoperative quality of life and intelligence quotient improvements were found in 43% (112/262) and 28% (67/242) of patients, respectively. Influence factors of postoperative quality of life and intelligence quotient improvement were postoperative seizure freedom and preoperative low intelligence quotient. The percentage of seizure freedom in the tuberectomy group was significantly lower compared to the tuberectomy plus and lobectomy groups at 1- and 4-year follow-ups. In conclusion, this study, the largest nationwide multi-centre study on resective epilepsy surgery, resulted in improved seizure outcomes and quality of life and intelligence quotient improvements in patients with tuberous sclerosis complex. Seizure freedom was often achieved in patients with an outstanding tuber on MRI, total removal of epileptogenic tubers, and tuberectomy plus. Quality of life and intelligence quotient improvements were frequently observed in patients with postoperative seizure freedom and preoperative low intelligence quotient.

更新日期：2020-02-10

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