Epilepsy Surgery in Young Children With Tuberous Sclerosis Complex: A Novel Hybrid Multimodal Surgical Approach.
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
01 02 2023
01 02 2023
Historique:
received:
22
04
2022
accepted:
31
08
2022
entrez:
13
1
2023
pubmed:
14
1
2023
medline:
18
1
2023
Statut:
ppublish
Résumé
Surgery has become integral in treating children with tuberous sclerosis complex (TSC)-related drug-resistant epilepsy (DRE). To describe outcomes of a multimodal diagnostic and therapeutic approach comprising invasive intracranial monitoring and surgical treatment and compare the complementary techniques of open resection and magnetic resonance-guided laser interstitial thermal therapy. Clinical and radiographic data were prospectively collected for pediatric patients undergoing surgical evaluation for TSC-related DRE at our tertiary academic hospital. Seizure freedom, developmental improvement, and Engel class were compared. Thirty-eight patients (20 females) underwent treatment in January 2016 to April 2019. Thirty-five underwent phase II invasive monitoring with intracranial electrodes: 24 stereoencephalography, 9 craniotomy for grid/electrode placement, and 2 grids + stereoencephalography. With the multimodal approach, 33/38 patients (87%) achieved >50% seizure freedom of the targeted seizure type after initial treatment; 6/9 requiring secondary treatment and 2/2 requiring a third treatment achieved >50% freedom. The median Engel class was II at last follow-up (1.65 years), and 55% of patients were Engel class I/II. The mean age was lower for children undergoing open resection (2.4 vs 4.9 years, P = .04). Rates of >50% reduction in seizures (86% open resection vs 88% laser interstitial thermal therapy) and developmental improvement (86% open resection vs 83% magnetic resonance-guided laser interstitial thermal therapy) were similar. This hybrid approach of using both open surgical and minimally invasive techniques is safe and effective in treating DRE secondary to TSC. Clinical trials focused on treatment method with longer follow-up are needed to determine the optimal candidates for each approach and compare the treatment modalities more effectively.
Sections du résumé
BACKGROUND
Surgery has become integral in treating children with tuberous sclerosis complex (TSC)-related drug-resistant epilepsy (DRE).
OBJECTIVE
To describe outcomes of a multimodal diagnostic and therapeutic approach comprising invasive intracranial monitoring and surgical treatment and compare the complementary techniques of open resection and magnetic resonance-guided laser interstitial thermal therapy.
METHODS
Clinical and radiographic data were prospectively collected for pediatric patients undergoing surgical evaluation for TSC-related DRE at our tertiary academic hospital. Seizure freedom, developmental improvement, and Engel class were compared.
RESULTS
Thirty-eight patients (20 females) underwent treatment in January 2016 to April 2019. Thirty-five underwent phase II invasive monitoring with intracranial electrodes: 24 stereoencephalography, 9 craniotomy for grid/electrode placement, and 2 grids + stereoencephalography. With the multimodal approach, 33/38 patients (87%) achieved >50% seizure freedom of the targeted seizure type after initial treatment; 6/9 requiring secondary treatment and 2/2 requiring a third treatment achieved >50% freedom. The median Engel class was II at last follow-up (1.65 years), and 55% of patients were Engel class I/II. The mean age was lower for children undergoing open resection (2.4 vs 4.9 years, P = .04). Rates of >50% reduction in seizures (86% open resection vs 88% laser interstitial thermal therapy) and developmental improvement (86% open resection vs 83% magnetic resonance-guided laser interstitial thermal therapy) were similar.
CONCLUSION
This hybrid approach of using both open surgical and minimally invasive techniques is safe and effective in treating DRE secondary to TSC. Clinical trials focused on treatment method with longer follow-up are needed to determine the optimal candidates for each approach and compare the treatment modalities more effectively.
Identifiants
pubmed: 36637274
doi: 10.1227/neu.0000000000002214
pii: 00006123-202302000-00021
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
398-406Informations de copyright
Copyright © Congress of Neurological Surgeons 2022. All rights reserved.
Références
Asano E, Chugani DC, Muzik O, et al. Multimodality imaging for improved detection of epileptogenic foci in tuberous sclerosis complex. Neurology. 2000;54(10):1976-1984.
Ohtsuka Y, Ohmori I, Oka E. Long-term follow-up of childhood epilepsy associated with tuberous sclerosis. Epilepsia. 1998;39(11):1158-1163.
Roach ES, Gomez MR, Northrup H. Tuberous sclerosis complex consensus conference: revised clinical diagnostic criteria. J Child Neurol. 1998;13(12):624-628.
Romanelli P, Weiner HL, Najjar S, Devinsky O. Bilateral resective epilepsy surgery in a child with tuberous sclerosis: case report. Neurosurgery. 2001;49(3):732-734; discussion 735.
Curatolo P. Neurological manifestations of tuberous sclerosis complex. Childs Nerv Syst. 1996;12(9):515-521.
O'Callaghan FJ, Harris T, Joinson C, et al. The relation of infantile spasms, tubers, and intelligence in tuberous sclerosis complex. Arch Dis Child. 2004;89(6):530-533.
Curatolo P, Cusmai R. The value of MRI in tuberous sclerosis. Neuropediatrics. 1987;18(3):184.
Koh S, Jayakar P, Dunoyer C, et al. Epilepsy surgery in children with tuberous sclerosis complex: presurgical evaluation and outcome. Epilepsia. 2000;41(9):1206-1213.
Webb DW, Fryer AE, Osborne JP. On the incidence of fits and mental retardation in tuberous sclerosis. J Med Genet. 1991;28(6):395-397.
Roach ES. Tuberous sclerosis: function follows form. J Child Neurol. 1997;12(2):75-76.
Shepherd CW, Houser OW, Gomez MR. MR findings in tuberous sclerosis complex and correlation with seizure development and mental impairment. AJNR Am J Neuroradiol. 1995;16(1):149-155.
Jozwiak S, Goodman M, Lamm SH. Poor mental development in patients with tuberous sclerosis complex: clinical risk factors. Arch Neurol. 1998;55(3):379-384.
Riikonen R, Simell O. Tuberous sclerosis and infantile spasms. Dev Med Child Neurol. 1990;32(3):203-209.
Weiner HL, Carlson C, Ridgway EB, et al. Epilepsy surgery in young children with tuberous sclerosis: results of a novel approach. Pediatrics. 2006;117(5):1494-1502.
Stellon MA, Cobourn K, Whitehead MT, Elling N, McClintock W, Oluigbo CO. “Laser and the tuber”: thermal dynamic and volumetric factors influencing seizure outcomes in pediatric subjects with tuberous sclerosis undergoing stereoencephalography-directed laser ablation of tubers. Childs Nerv Syst. 2019;35(8):1333-1340.
Bye AM, Matheson JM, Tobias VH, Mackenzie RA. Selective epilepsy surgery in tuberous sclerosis. Aust Paediatr J. 1989;25(4):243-245.
Weiner HL, Ferraris N, LaJoie J, Miles D, Devinsky O. Epilepsy surgery for children with tuberous sclerosis complex. J Child Neurol. 2004;19(9):687-689.
Bebin EM, Kelly PJ, Gomez MR. Surgical treatment for epilepsy in cerebral tuberous sclerosis. Epilepsia. 1993;34(4):651-657.
Baumgartner JE, Wheless JW, Kulkarni S, et al. On the surgical treatment of refractory epilepsy in tuberous sclerosis complex. Pediatr Neurosurg. 1997;27(6):311-318.
North RY, Raskin JS, Curry DJ. MRI-guided laser interstitial thermal therapy for epilepsy. Neurosurg Clin N Am. 2017;28(4):545-557.
Tovar-Spinoza Z, Ziechmann R, Zyck S. Single and staged laser interstitial thermal therapy ablation for cortical tubers causing refractory epilepsy in pediatric patients. Neurosurg Focus. 2018;45(3):E9.
Lee JJ, Clarke D, Hoverson E, Tyler-Kabara EC, Ho WS. MRI-guided laser interstitial thermal therapy using the Visualase system and Navigus frameless stereotaxy in an infant: technical case report. J Neurosurg Pediatr. 2021;28:50-53.
Neal A, Ostrowsky-Coste K, Jung J, et al. Epileptogenicity in tuberous sclerosis complex: a stereoelectroencephalographic study. Epilepsia. 2020;61(1):81-95.
Ma TS, Elliott RE, Ruppe V, et al. Electrocorticographic evidence of perituberal cortex epileptogenicity in tuberous sclerosis complex. J Neurosurg Pediatr. 2012;10(5):376-382.
Duncan JS. The promise of new antiepileptic drugs. Br J Clin Pharmacol. 2002;53(2):123-131.
Engel J. Surgical Treatment of the Epilepsies, 2nd ed. Raven Press; 1993.
Cobourn K, Fayed I, Keating RF, Oluigbo CO. Early outcomes of stereoelectroencephalography followed by MR-guided laser interstitial thermal therapy: a paradigm for minimally invasive epilepsy surgery. Neurosurg Focus. 2018;45(3):E8.
Curry DJ, Gowda A, McNichols RJ, Wilfong AA. MR-guided stereotactic laser ablation of epileptogenic foci in children. Epilepsy Behav. 2012;24(4):408-414.
Hooten KG, Werner K, Mikati MA, Muh CR. MRI-guided laser interstitial thermal therapy in an infant with tuberous sclerosis: technical case report. J Neurosurg Pediatr. 2018;23(1):92-97.
Lewis EC, Weil AG, Duchowny M, Bhatia S, Ragheb J, Miller I. MR-guided laser interstitial thermal therapy for pediatric drug-resistant lesional epilepsy. Epilepsia. 2015;56(10):1590-1598.
Fohlen M, Taussig D, Ferrand-Sorbets S, et al. Refractory epilepsy in preschool children with tuberous sclerosis complex: early surgical treatment and outcome. Seizure. 2018;60:71-79.
Arya R, Tenney JR, Horn PS, et al. Long-term outcomes of resective epilepsy surgery after invasive presurgical evaluation in children with tuberous sclerosis complex and bilateral multiple lesions. J Neurosurg Pediatr. 2015;15(1):26-33.
Krsek P, Jahodova A, Kyncl M, et al. Predictors of seizure-free outcome after epilepsy surgery for pediatric tuberous sclerosis complex. Epilepsia. 2013;54(11):1913-1921.
Liang S, Zhang J, Yang Z, et al. Long-term outcomes of epilepsy surgery in tuberous sclerosis complex. J Neurol. 2017;264(6):1146-1154.
Romanelli P, Najjar S, Weiner HL, Devinsky O. Epilepsy surgery in tuberous sclerosis: multistage procedures with bilateral or multilobar foci. J Child Neurol. 2002;17(9):689-692.
Weiner HL. Tuberous sclerosis and multiple tubers: localizing the epileptogenic zone. Epilepsia. 2004;45(suppl 4):41-42.
Moshel YA, Elliott R, Teutonico F, et al. Do tubers contain function? Resection of epileptogenic foci in perirolandic cortex in children with tuberous sclerosis complex. Epilepsia. 2010;51(7):1242-1251.