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Epilepsy surgery in children with tuberous sclerosis complex: presurgical evaluation and outcome

S Koh1, P Jayakar, C Dunoyer

  • 1Comprehensive Epilepsy Center, Miami Children's Hospital, Florida, USA.

Epilepsia
|September 22, 2000
PubMed

Insights

Focal resection of the epileptogenic tuber/region (ET/R) in children with tuberous sclerosis complex (TSC) significantly reduces seizures. Noninvasive studies like EEG and MRI effectively localize the ET/R for successful surgical intervention.

Area of Science:

  • Pediatric Neurology
  • Epileptology
  • Neurosurgery

Background:

  • Tuberous sclerosis complex (TSC) is a genetic disorder associated with epilepsy.
  • Surgical resection of the epileptogenic tuber/region (ET/R) can be effective for intractable seizures in children with TSC.
  • Accurate localization of the ET/R is crucial for successful surgical outcomes.

Purpose of the Study:

  • To evaluate the role of noninvasive studies in localizing the ET/R in children with TSC.
  • To assess the outcomes of focal resection guided by these localization methods.

Main Methods:

  • Twenty-one children with TSC underwent video-electroencephalogram (EEG) and magnetic resonance imaging (MRI).
  • Ictal single photon emission-computed tomography (SPECT) was performed in 18 patients.
  • Localization of the ET/R was achieved in 17 patients, with 13 undergoing surgical resection.

Main Results:

  • Scalp EEG identified a principal spike focus (PSF) corresponding to the ET/R in 14 children.
  • MRI revealed tubers, with the ET/R correlating to large discrete or calcified tubers in most cases.
  • Post-surgery, 9 of 13 children were seizure-free, with significant seizure reduction in others.

Conclusions:

  • Surgical resection of the ET/R is effective in alleviating intractable epilepsy in most children with TSC.
  • Scalp EEG and MRI are valuable tools for defining the ET/R and guiding surgical selection.
  • These noninvasive methods improve case selection, especially when ictal SPECT is nonlocalizing.
Abstract

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