{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T03:28:43Z","timestamp":1785900523526,"version":"3.56.0"},"reference-count":124,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Patients with tuberous sclerosis complex (TSC), while considered genetically homogeneous, are clinically heterogeneous and present unique challenges for epilepsy surgery evaluation and treatment. Thus, the authors\u2019 goal was to identify factors associated with seizure outcomes in children with TSC who had undergone epilepsy surgery.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The PubMed, MEDLINE, Embase, CINAHL, and Web of Science databases were queried for relevant articles. Patients from the TSC Alliance registry and Children\u2019s of Alabama were also included. Eligible studies were those reporting individual participant data on the seizure outcomes of pediatric patients with TSC who had undergone epilepsy surgery. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and a meta-analysis was performed using a random-effects logistic regression model. Individual factors and seizure outcome following epilepsy surgery at the latest reported follow-up were tested for association. The primary outcome was a good seizure outcome, defined as Engel class I or II, International League Against Epilepsy class 1, 2, or 3, or \u2264 3 seizures per year following surgery.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n From 44 studies eligible for systematic review and 2 additional sources, there were 2058 patients. Of these, 1338 (65%) patients had available surgical outcome data and a median follow-up of 2.5 years (IQR 1.0\u20135.0 years). Overall, 878 (66%) patients had a good seizure outcome. Such an outcome was associated with \u2264 1 visible tuber on MRI (OR 4.8, p = 0.01, 95% CI 1.44\u201315.94, I\n 2<\/jats:sup>\n = 0%); however, a good seizure outcome was less likely in patients with no or mild cognitive delay (OR 0.52, p = 0.02, 95% CI 0.30\u20130.09, I\n 2<\/jats:sup>\n = 11%) or in those with no or unifocal interictal scalp EEG abnormality (OR 0.36, p = 0.01, 95% CI 0.16\u20130.80, I\n 2<\/jats:sup>\n = 24%). Preoperative IQ (treated as a continuous variable, OR 0.98, p = 0.009, 95% CI 0.96\u20130.99, I\n 2<\/jats:sup>\n = 0%) had little to no effect on seizure outcome. Two (5%) studies met the criteria for a low risk of bias, 28 (64%) met the criteria for a moderate risk of bias, and 14 (32%) met the criteria for a serious risk of bias.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The authors identified several factors associated with seizure outcomes in TSC patients who had undergone epilepsy surgery. However, the study findings should be interpreted with caution, as they represent an aggregation of largely retrospective cohort or case studies with a high potential for bias.<\/jats:p>\n \n Systematic review registration no.: CRD42023393588 (\n www.crd.york.ac.uk\/prospero\/<\/jats:ext-link>\n )\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2024.12.peds24311","type":"journal-article","created":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T23:01:03Z","timestamp":1744412463000},"page":"599-611","source":"Crossref","is-referenced-by-count":4,"title":["Epilepsy surgery outcomes in children with tuberous sclerosis complex: a systematic review and meta-analysis"],"prefix":"10.3171","volume":"35","author":[{"given":"Andrew T.","family":"Hale","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Alabama at Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cody","family":"Savage","sequence":"additional","affiliation":[{"name":"Heersink School of Medicine, University of Alabama at Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dagoberto","family":"Estevez-Ordonez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Alabama at Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tucker","family":"Oliver","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Georgia at Augusta University, Augusta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Hedaya","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neurology, University of Alabama at Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelly","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Nicklaus Children\u2019s Hospital, Miami, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Ragheb","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Nicklaus Children\u2019s Hospital, Miami, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aglaia","family":"Vignoli","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Neuropsychiatry, Department of Health Sciences, University of Milan, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tinghong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Children\u2019s Hospital, Capital Medical University, Beijing, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liu","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Children\u2019s Hospital, Capital Medical University, Beijing, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangshuo","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Children\u2019s Hospital, Capital Medical University, Beijing, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srinivas","family":"Chivukula","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mattel Children\u2019s Hospital, University of California, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aria","family":"Fallah","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mattel Children\u2019s Hospital, University of California, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismail","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neurology, University of Alabama at Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Martina","family":"Bebin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neurology, University of Alabama at Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Curtis J.","family":"Rozzelle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Alabama at Birmingham, Alabama;"},{"name":"Division of Pediatric Neurosurgery, Children\u2019s of Alabama, Birmingham, Alabama; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard L.","family":"Weiner","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Texas Children\u2019s Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuli","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Children\u2019s Hospital, Capital Medical University, Beijing, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey P.","family":"Blount","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Alabama at Birmingham, Alabama;"},{"name":"Division of Pediatric Neurosurgery, Children\u2019s of Alabama, Birmingham, Alabama; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"9114","key":"b1","series-title":"Lancet","first-page":"1490","article-title":"Prevalence of tuberous sclerosis estimated by capture-recapture analysis","volume":"351","author":"O\u2019Callaghan FJ","year":"1998","unstructured":"O\u2019Callaghan FJ, Shiell AW, Osborne JP, Martyn CN. 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