Epilepsy surgery in children with tuberous sclerosis

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OBJECTIVE

To evaluate some demographic and clinical variables probably related to seizure outcome.

MATERIAL AND METHODS

Thirty-three children, median age 4.2 ys (7.5 mths—16 ys), with TS and DR-epilepsy underwent surgery. Within overall 38 procedures (redo surgery was needed in 5 cases), tuberectomy (with or without perituberal cortectomy) was performed in 21 cases, lobectomy — 8, callosotomy — 3, various disconnections (anterior frontal, TPO and hemispherotomy) — 6 patients. Standard preoperative evaluation included MRI and video-EEG. Invasive recordings were used in 8 cases, coupled by MEG and SISCOM SPECT in some cases. ECOG and neuronavigation were used routinely during tuberectomies, and stimulation and mapping were employed in cases with lesions overlapping or near to eloquent cortex. Surgical complications: wound CSF leak (n=1) and hydrocephalus (n=2) were noted in 7.5% of cases. Postoperative neurological deficit (most frequently hemiparesis) developed in 12 patients, being temporary in majority of them. At the last FU (med 5.4 ys) favorable outcome (Engel I) has been achieved in 18 cases (54%), while 7 patients (15%) with persisting seizures reported less common attacks and their milder form (Engel Ib-III). Six patients were able to discontinue AED-treatment and 15 children resumed development and markedly improved in cognition and behavior.

RESULTS AND CONCLUSION

Among different variables potentially influencing the outcome after epilepsy surgery in cases with TS, the most important one is seizure type. If prevalent, focal type may be a biomarker of favorable outcomes and probability to become free of seizures.

Keywords:

pediatric epilepsy surgery

tuberous sclerosis

outcome

prognosis

Authors:

Melikyan A.G.

Burdenko Neurosurgical Center

Kozlova A.B.

Burdenko Neurosurgical Center

Vlasov P.A.

Burdenko Neurosurgical Center

Dorofeeva M.Yu.

Veltishchev Research and Clinical Institute for Pediatrics and Pediatric Surgery

ORCID: 0000-0001-7879-315X

Shishkina L.V.

Burdenko Neurosurgical Center

Agrba S.B.

Burdenko Neurosurgical Center

Received:

29.09.2022

Accepted:

27.01.2023

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