Jansen Floor E, van Huffelen Alexander C, Algra Ale, van Nieuwenhuizen Onno
Department of Child Neurology, Rudolf Magnus Institute of Neuroscience and Julius Centre for Health Sciences and Primary Care, University Medical Centre, 3508 GA Utrecht, The Netherlands.
Epilepsia. 2007 Aug;48(8):1477-84. doi: 10.1111/j.1528-1167.2007.01117.x. Epub 2007 May 1.
Tuberous sclerosis complex (TSC) is often associated with intractable epilepsy. Although epilepsy surgery has gained interest in recent years uncertainties exist about which patients are good surgical candidates. A systematic review of the available literature has been undertaken to assess the overall outcome of epilepsy surgery and identify risk factors of seizure recurrence.
We searched MEDLINE, Embase, and bibliographies of reviews and book chapters to identify articles published in English since 1960. Twenty-five articles, describing postoperative seizure outcome and type of surgery in 177 TSC patients, were included in this study. Seizure outcome was analyzed both as seizure freedom and good outcome, including patients with >90% seizure reduction.
Seizure freedom was achieved in 101 patients (57%). Seizure frequency was improved by > 90% in 32 patients (18%). Moderate or severe intellectual disability (IQ < 70) (RR 1.8; 95% CI 1.2-2.8) and the presence of tonic seizures (RR 1.7; 95 % CI 1.2-2.4) were related to seizure recurrence.
A relation between multiple seizures types with early onset, multiple cortical tubers and multifocal epileptogenicity, and poor outcome is not supported by this systematic analysis. Although there is considerable variation among studies reviewed here, the literature suggests that resective surgery may offer benefit in a selected population of TSC patients with drug-resistant epilepsy.
结节性硬化症（TSC）常与难治性癫痫相关。尽管近年来癫痫手术受到关注，但对于哪些患者是合适的手术候选者仍存在不确定性。已对现有文献进行系统综述，以评估癫痫手术的总体结果并确定癫痫复发的危险因素。
我们检索了MEDLINE、Embase以及综述和书籍章节的参考文献，以识别自1960年以来以英文发表的文章。本研究纳入了25篇描述177例TSC患者术后癫痫发作结果和手术类型的文章。癫痫发作结果分析包括无癫痫发作和良好结果，良好结果包括癫痫发作减少>90%的患者。
101例患者（57%）实现了无癫痫发作。32例患者（18%）的癫痫发作频率改善>90%。中度或重度智力残疾（智商<70）（风险比1.8；95%置信区间1.2 - 2.8）和强直发作的存在（风险比1.7；95%置信区间1.2 - 2.4）与癫痫复发相关。
本系统分析不支持多种发作类型伴早发、多个皮质结节和多灶性致痫性与不良结果之间的关系。尽管此处综述的研究之间存在相当大的差异，但文献表明，切除性手术可能对选定的耐药性癫痫TSC患者群体有益。
