Abstracts

Cortical tubers are associated with epilepsy and intellectual disability in the majority of patients with tuberous sclerosis. Seizures are often drug resistant. Uncertainties exist concerning the selection of patients suitable for epilepsy surgery. We performed a systematic review of the available literature to assess the overall outcome of epilepsy surgery and to identify factors related to good seizure outcome., A comprehensive literature search of Medline, Embase, and bibliographies of reviews and book chapters published from 1960 until May 2006 was performed. Studies were included if they at least reported quantitative seizure outcome, and a description of the type of surgery. Seizure outcome was analysed both as seizure freedom and good seizure outcome (seizure reduction of [gt]90%) versus poor seizure outcome., Twentyfive studies, including 177 patients, were found to be eligible. Seizure freedom was achieved in 101 patients (57%). Seizure frequency was reduced by [gt] 90% in another 32 patients (18%). Moderate or severe intellectual disability (IQ [lt]70) (RR 1.8; 95% CI 1.2- 2.8), the presence of tonic seizures (RR 1.7; 95 % CI 1.2- 2.4) multifocal abnormality on SPECT examination (RR 7.0; 95% CI 1.1- 43) and corpus callosotomy (corpus callosotomy versus resective surgery RR 2.5; 95% CI 2.1- 3.0) predicted an unfavourable outcome., A good outcome of surgery (seizures reduction of [gt] 90% or complete cure) was achieved in 75% of patients. Resective epilepsy surgery should be considered in all drug resistant TSC patient, as a relation between multiple seizure types with early onset, multiple cortical tubers and multifocal or generalized epileptogenicity and a poor outcome is not supported., (Supported by the Epilepsy Fund of the Netherlands (grant number 02-13, F.E.J.).)