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Epilepsy Research and Treatment
Volume 2012 (2012), Article ID 135364, 5 pages
http://dx.doi.org/10.1155/2012/135364
Research Article

Changing Global Trends in Seizure Outcomes Following Resective Surgery for Tuberous Sclerosis in Children with Medically Intractable Epilepsy

1Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
2Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
3Hospital for Sick Children Research Institute, Suite 1503, 555 University Avenue, Toronto, ON, Canada M5G 1X8
4Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
5Department of Neurology, Hospital for Sick Children, Toronto, ON, Canada

Received 9 September 2012; Accepted 30 October 2012

Academic Editor: Raidah S. Albaradie

Copyright © 2012 George M. Ibrahim et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Tuberous sclerosis (TS) is the leading cause of genetic epilepsy worldwide. Here, we evaluate changes in seizure outcomes following resective epilepsy surgery in children with TS over time. Methods. A systematic review of the literature was performed to identify studies reporting seizure outcomes following resective epilepsy surgery in children with TS. Using an individual participant meta-analysis approach, seizure outcomes and associated covariates were combined. Multivariate logistic regression was used to determine significant associations between seizure outcomes and time of surgery. Results. Twenty studies from 1966 to present, yielding 186 participants, met the inclusion criteria for the study. On univariate analysis, there was a significant improvement in seizure outcomes in children who underwent resective epilepsy surgery within the last 15 years compared to older cohorts (chi-square 4.1; ). On multivariate analysis, adjusting for length of followup, this trend was not significant (OR 0.52; 95% CI 0.23–1.17; ). In the last 15 years, a greater proportion of younger children also underwent resective surgery compared to older cohorts (OR 0.93; 95% CI 0.89–0.97; ). Conclusions. A trend towards improved seizure outcomes following resective surgery for TS was observed from 1966 to present on multivariate analysis.