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The evolution of epilepsy surgery in tuberous sclerosis in Sweden: A national registry study

Pearson, Kevin LU orcid ; Eklund, Erik LU ; Rask, Olof LU ; Rosén, Ingmar LU ; Sjunnesson, Håkan LU and COMPAGNO STRANDBERG, MARIA LU (2023) In Seizure 112. p.54-61
Abstract
Purpose
This study aimed to characterize the Swedish cohort of surgically treated patients with TSC and explore differences in preoperative investigation and outcome over time.
Methods
Data on patient and seizure characteristics were retrieved from the Swedish National Epilepsy Surgery Register. Two-year follow-up results were compared between the years 1997–2010 and 2011–2018. Preoperative investigations were re-evaluated.
Results
Eighteen tuberectomies and seven callosotomies were identified. Seizure freedom after tuberectomy was achieved in 11 % (1/9) 1997–2010 and 56 % (5/9) 2011–2018. The number of tuberectomies increased each decade. Patients operated on in 1997–2010 had higher seizure frequency (median 175... (More)
Purpose
This study aimed to characterize the Swedish cohort of surgically treated patients with TSC and explore differences in preoperative investigation and outcome over time.
Methods
Data on patient and seizure characteristics were retrieved from the Swedish National Epilepsy Surgery Register. Two-year follow-up results were compared between the years 1997–2010 and 2011–2018. Preoperative investigations were re-evaluated.
Results
Eighteen tuberectomies and seven callosotomies were identified. Seizure freedom after tuberectomy was achieved in 11 % (1/9) 1997–2010 and 56 % (5/9) 2011–2018. The number of tuberectomies increased each decade. Patients operated on in 1997–2010 had higher seizure frequency (median 175 seizures/month vs. 102) and incidence of infantile spasms (4/9 vs. 1/9, none after 2011). There was a trend towards surgery at a younger age (median 86 months 1997–2010 vs. 48 months 2011–2018). None with >200 seizure/month, SEGA, or history of infantile spasms achieved seizure freedom. Two patients underwent anterior callosotomy (1992 and 1994) and became free of drop attacks. Five callosotomies were performed between 2011 and 2013, one patient became free of drop attacks. Two complications with new neurological deficits were reported. The median age at surgery was higher in the callosotomy group (14 years) than in the tuberectomy group (5 years).
Conclusion
Seizure freedom after tuberectomy in patients with TSC has increased over time in our cohort. Signs of a heavier disease burden were more frequently observed 1997–2010 and associated with worse outcomes. Callosotomy operations were prevalent at the beginning of the 2010s. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Seizure
volume
112
pages
54 - 61
publisher
Elsevier
external identifiers
  • scopus:85172347171
  • pmid:37757549
ISSN
1532-2688
DOI
10.1016/j.seizure.2023.09.016
language
English
LU publication?
yes
id
93f88122-d550-42f2-8d15-43996090916a
date added to LUP
2023-09-27 15:03:44
date last changed
2023-12-28 03:00:39
@article{93f88122-d550-42f2-8d15-43996090916a,
  abstract     = {{Purpose<br/>This study aimed to characterize the Swedish cohort of surgically treated patients with TSC and explore differences in preoperative investigation and outcome over time.<br/>Methods<br/>Data on patient and seizure characteristics were retrieved from the Swedish National Epilepsy Surgery Register. Two-year follow-up results were compared between the years 1997–2010 and 2011–2018. Preoperative investigations were re-evaluated.<br/>Results<br/>Eighteen tuberectomies and seven callosotomies were identified. Seizure freedom after tuberectomy was achieved in 11 % (1/9) 1997–2010 and 56 % (5/9) 2011–2018. The number of tuberectomies increased each decade. Patients operated on in 1997–2010 had higher seizure frequency (median 175 seizures/month vs. 102) and incidence of infantile spasms (4/9 vs. 1/9, none after 2011). There was a trend towards surgery at a younger age (median 86 months 1997–2010 vs. 48 months 2011–2018). None with &gt;200 seizure/month, SEGA, or history of infantile spasms achieved seizure freedom. Two patients underwent anterior callosotomy (1992 and 1994) and became free of drop attacks. Five callosotomies were performed between 2011 and 2013, one patient became free of drop attacks. Two complications with new neurological deficits were reported. The median age at surgery was higher in the callosotomy group (14 years) than in the tuberectomy group (5 years).<br/>Conclusion<br/>Seizure freedom after tuberectomy in patients with TSC has increased over time in our cohort. Signs of a heavier disease burden were more frequently observed 1997–2010 and associated with worse outcomes. Callosotomy operations were prevalent at the beginning of the 2010s.}},
  author       = {{Pearson, Kevin and Eklund, Erik and Rask, Olof and Rosén, Ingmar and Sjunnesson, Håkan and COMPAGNO STRANDBERG, MARIA}},
  issn         = {{1532-2688}},
  language     = {{eng}},
  pages        = {{54--61}},
  publisher    = {{Elsevier}},
  series       = {{Seizure}},
  title        = {{The evolution of epilepsy surgery in tuberous sclerosis in Sweden: A national registry study}},
  url          = {{http://dx.doi.org/10.1016/j.seizure.2023.09.016}},
  doi          = {{10.1016/j.seizure.2023.09.016}},
  volume       = {{112}},
  year         = {{2023}},
}