title: Are cortical tubers epileptogenic? Evidence from electrocorticography.
abstract: The purpose of this study was to characterize the epileptogenicity of tubers and surrounding cortex in patients with tuberous sclerosis complex (TSC). Three pediatric patients with TSC and intractable epilepsy underwent surgical resection of tubers associated with epileptogenic foci. In all patients, presurgical imaging revealed a prominent tuber that correlated on electroencephalography (EEG) with frequent interictal epileptiform discharges and electrographic seizures. Intracranial electrocorticography (ECoG) was performed using subdural grids placed over the tuber and surrounding cortex and depth electrodes positioned directly within the tuber. In all three patients, the depth electrode within the tuber was electrographically silent, whereas the surrounding cortical tissue showed significant epileptiform activity. The tuber and the electrically active adjacent cortex were resected. The patients experienced a drastic reduction in seizure frequency postsurgery. Epileptogenicity of cortical tubers may derive not from the lesion itself, but rather from the perturbation or abnormal development of the surrounding cortex.
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Philippe
authors.initials: P
authors.lastname: Major
authors.forename: Sonja
authors.initials: S
authors.lastname: Rakowski
authors.forename: Mirela V
authors.initials: MV
authors.lastname: Simon
authors.forename: Ming L
authors.initials: ML
authors.lastname: Cheng
authors.forename: Emad
authors.initials: E
authors.lastname: Eskandar
authors.forename: Joshua
authors.initials: J
authors.lastname: Baron
authors.forename: Beth A
authors.initials: BA
authors.lastname: Leeman
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Frosch
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Thiele
mesh_terms: D000293:Adolescent; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D014402:Tuberous Sclerosis / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology