Bilateral resective epilepsy surgery in a child with tuberous sclerosis: case report
Related Experiment Video
Updated: Oct 4, 2026
Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy
Published on: September 20, 2024
P Romanelli1, H L Weiner, S Najjar
1Department of Neurosurgery, New York University-Mount Sinai Comprehensive Epilepsy Center, New York University Medical Center, New York 10016, USA.
Insights
Aggressive bilateral surgery can effectively treat severe epilepsy in children with tuberous sclerosis (TS) and multiple seizure foci. This approach improved seizure control and developmental outcomes in a challenging case.
Area of Science:
- Pediatric Neurology
- Epilepsy Surgery
- Tuberous Sclerosis Complex
Background:
- Tuberous sclerosis (TS) is a genetic disorder that can cause epilepsy and developmental delays.
- Medically refractory epilepsy in TS often requires surgical intervention.
- Identifying and treating bilateral seizure foci presents a surgical challenge.
Observation:
- A child with TS experienced severe epilepsy and developmental delay from infancy.
- Video-electroencephalography identified independent seizure foci in the left temporal and right parietal regions.
- Bilateral subdural electrodes confirmed independent seizure onsets.
Findings:
- The patient underwent staged bilateral resections, first of the right parietal focus and then the left temporal focus.
- Post-surgery, tonic-clonic and complex partial seizures ceased.
- Simple partial seizures were reduced by over 80%, with complete elimination of others.
- Significant improvements in cognitive and motor development were observed.
Implications:
- Aggressive bilateral epilepsy surgery can be safe and effective in selected TS patients with bilateral foci.
- This surgical strategy may improve seizure control and neurodevelopmental outcomes.
- Multifocal epilepsy in TS warrants consideration of bilateral surgical interventions.
Objective And Importance:
Surgical intervention can reduce the burden of seizures in selected patients with tuberous sclerosis and medically refractory epilepsy.
Clinical Presentation:
A child presented with tuberous sclerosis and severe epilepsy beginning in the first month of life and delayed development before 1 year of age. Video-electroencephalographic monitoring at the age of 1 year revealed a left temporal seizure focus. Repeat videoelectroencephalography at 2 years of age revealed a right posterior quadrant seizure focus. Bilateral subdural electrodes were placed, confirming independent seizure onsets from the right parietal area (overlying a tuber) and prominent interictal activity over the left superior temporal region.
Intervention:
The right parietal focus was resected, and electrodes were maintained over the left temporal focus. After right parietal resection, ictal discharges were recorded over the left temporal region; a corticectomy was performed 2 days later. No tonicoclonic or complex partial seizures have occurred during a follow-up period of more than 24 months. Simple partial motor seizures involving the right foot have been reduced by more than 80%, and other simple partial seizures have been eliminated. Postoperatively, there has been marked improvement in the patient's cognitive and motor developmental status.
Conclusion:
In selected patients with bilateral seizure foci involving separate lobes, aggressive bilateral surgery can be safe and effective.
