Predictors of seizure freedom after surgical management of tuberous sclerosis complex: a systematic review and meta-analysis

Abstract

Purpose: To evaluate the rate of seizure freedom in surgical management of tuberous sclerosis complex (TSC) and to identify factors associated with postoperative seizure outcome.

Methods: A comprehensive literature search identified articles published since 1990 that described seizure outcomes in patients with TSC who underwent resective surgery. Two reviewers assessed article eligibility and independently extracted the data. Eleven potential prognostic variables were identified and dichotomized for analyses. Random or fixed effects meta-analyses were used depending on the presence or absence of heterogeneity.

Results: Among 229 patients in 13 studies, the pooled rate of postoperative seizure freedom was 59%. Seizure onset later than 1 year of age, unilateral focality in interictal or ictal electroencephalography, and lobectomy were significantly associated with a higher rate of seizure freedom.

Conclusions: Our findings indicate that surgery is an effective treatment modality for TSC patients. The meta-analyses provided useful evidence-based information for identifying TSC candidates for epilepsy surgery and planning surgical strategy.

Keywords: Epilepsy surgery; Meta-analysis; Outcome; Seizure freedom; Tuberous sclerosis complex.