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Bilateral resective epilepsy surgery in a child with tuberous sclerosis: case report
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.
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.