Epilepsy surgery for children with tuberous sclerosis complex.
Tuberous sclerosis complex is associated with medically refractory seizures and developmental delay in children. These epilepsies are often resistant to antiepileptic drugs, can be quite severe, and usually have a negative impact on the child's neurologic and cognitive development. It is believed that functional outcome is improved if seizures can be controlled at an early age. The surgical treatment of intractable epilepsy in children and adults with tuberous sclerosis complex has gained significant interest in recent years. Previously published studies have shown a potential benefit from resection of single tubers, with most of the results noted in relatively older children. All of these reports support the idea that if a single primary epileptogenic tuber or region can be identified, then a surgical approach is appropriate. However, most children with tuberous sclerosis complex have multiple potentially epileptogenic tubers, rendering localization challenging, and they are therefore rejected as possible surgical candidates. We have used a novel surgical approach using invasive intracranial monitoring, which is typically multistaged and bilateral. This multistage surgical approach has been useful in identifying both primary and secondary epileptogenic zones in patients with tuberous sclerosis complex with multiple tubers. Multiple or bilateral seizure foci are not necessarily a contraindication to surgery in selected patients. Long-term follow-up will determine whether this approach has durable effects. We await better methods for identifying the epileptogenic zone, both noninvasive and invasive.
Weiner
Howard L
HL
Division of Pediatric Neurosurgery, Department of Neurosurgery, New York University Medical Center, New York, NY 10016, USA. howard.weiner@med.nyu.edu
Ferraris
Nina
N
LaJoie
Josiane
J
Miles
Daniel
D
Devinsky
Orrin
O
D000367:Age Factors; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D004569:Electroencephalography; D004827:Epilepsy / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019635:Neurosurgical Procedures / Q000379:methods*; D012720:Severity of Illness Index; D014402:Tuberous Sclerosis / Q000150:complications*
D000927:Anticonvulsants