Surgical treatment of epilepsy in tuberous sclerosis: strategies and results in 18 patients.
BACKGROUND
Seizures in patients with tuberous sclerosis complex (TSC) are often intractable to antiepileptic medications and searching investigation may provide evidence that surgical treatment can be considered.


OBJECTIVE
To review the results of investigation and surgical therapy, a treatment modality not generally considered in patients with medically refractory seizures and TSC.


METHODS
We report 18 patients (9 male) with TSC who underwent surgical treatment of medically refractory epilepsy. Twelve patients had a well-localized epileptogenic lesion and were treated by lesionectomy or focal resection. Resections were: 7 frontal, 4 temporal, 1 frontotemporal, 1 occipital, and 1 frontoparietal. Four patients underwent more than one operation. Six patients had corpus callosotomy (CC).


RESULTS
Follow-up ranged from 1 month to 47 years. Outcome of the patients treated by resection was excellent in 7 (5 were seizure-free and 2 had auras only), good in 1, fair in 3, and 1 was lost to follow-up. Best outcome was obtained in patients who had focal seizures and good imaging and EEG correlation, although they might have multiple seizure types, other imaging abnormalities, and multifocal or generalized EEG findings. When there was no such correlation, CC was found to be an option as five patients had at least some improvement and only one showed no change.


CONCLUSIONS
Surgical treatment of patients with TSC and intractable epilepsy is most effective when a single tuber or epileptogenic area can be identified as the source of seizures and resected. This may be possible even when other tubers or diffuse EEG abnormalities are present. In patients with unlocalizable epileptic abnormalities, palliation may be obtained by CC.
Guerreiro
M M
MM
Department of Neurology and Neurosurgery, and Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada.
Andermann
F
F
Andermann
E
E
Palmini
A
A
Hwang
P
P
Hoffman
H J
HJ
Otsubo
H
H
Bastos
A
A
Dubeau
F
F
Snipes
G J
GJ
Olivier
A
A
Rasmussen
T
T
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001921:Brain / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014402:Tuberous Sclerosis / Q000150:complications* / Q000601:surgery*