Epilepsy surgery in tuberous sclerosis: the Dutch experience

Area of Science:

• Neurology
• Neurosurgery
• Epileptology

Background:

• Drug-resistant epilepsy affects over 50% of patients with tuberous sclerosis complex (TSC).
• Epilepsy surgery offers an alternative treatment if the epileptogenic tuber is reliably identified.
• Pre-surgical evaluation is crucial to determine suitability and predict outcomes.

Purpose of the Study:

• To report the pre-surgical identification of epileptogenic tubers in TSC patients.
• To evaluate the post-surgical outcomes of epilepsy surgery in TSC patients.
• To assess the safety and efficacy of epilepsy surgery for drug-resistant epilepsy in TSC.

Main Methods:

• Twenty-five TSC patients underwent comprehensive pre-surgical evaluation.
• Methods included detailed seizure history, video EEG, 3D FLAIR MRI, and neuropsychological testing.
• Patient suitability for surgery was determined by consensus, with outcomes assessed using the Engel classification.

Main Results:

• Epilepsy surgery was performed in six patients, with four achieving Engel classification 1 (seizure freedom).
• Two patients achieved Engel classification 4, indicating persistent disabling seizures.
• Nineteen patients did not undergo surgery due to non-concordant diagnostic findings or diminished seizure burden.

Conclusions:

• Epilepsy surgery is safe and effective in TSC patients with concordant pre-surgical findings (semiology, EEG, MEG, tuber location).
• For non-concordant cases, the risks of surgery must be weighed against potential seizure relief.
• The impact on neurodevelopment, especially in children, should be considered in treatment decisions.