Surgical treatment of epilepsy associated with tuberous sclerosis in children: a single-center retrospective study

Berdinov FB, Levov AV, Solovev VB, et al. . Surgical treatment of epilepsy associated with tuberous sclerosis in children: a single-center retrospective study. Burdenko's Journal of Neurosurgery. 2025;89(3):17‑27. (In Russ., In Engl.)
https://doi.org/10.17116/neiro20258903117

Подписка 2025 Журнал «Вопросы нейрохирургии» имени Н.Н. Бурденко (Burdenko's Journal of Neurosurgery)

Использование инфографики авторами научных работ

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BACKGROUND

The most common symptom of CNS damage in tuberous sclerosis is epilepsy. The last one is drug-resistant in most cases. Surgical treatment should be considered in these patients.

OBJECTIVE

To analyze the results of surgical treatment of drug-resistant epilepsy in children with tuberous sclerosis, to identify predictors of successful treatment.

MATERIAL AND METHODS

A retrospective study included 45 children between 2017 and 2023. In addition to standard non-invasive procedures, preoperative management included stereo-EEG in 19 cases, subdural EEG in 2 cases and staged subdural and stereo-EEG in 1 case. Selective tuberectomy was performed in 15 patients, tuberectomy (+) — in 16 children, lobectomy — in 6, multilobar resection — in 4, posterior quadrant disconnection — in 2, hemisphrotomy — in 2, repeated surgeries — in 6 children.

RESULTS

The median follow-up was 27 months. Postoperative outcomes ILAE grade I, IV, V and VI were observed in 62%, 25%, 11% and 2% of cases, respectively. Antiepileptic therapy was discontinued in 4.4% of cases. In 22.2% of patients, doses of drugs were reduced. Epileptogenic zone in frontal lobe favorably affected postoperative outcome (p=0.027). Transient hemiparesis occurred in 5 (11.1%) cases, persistent expected hemiparesis — in 1 (2.2%) case.

CONCLUSION

Surgical treatment is effective for epilepsy in children with tuberous sclerosis. It is advisable to refer children with epilepsy and tuberous sclerosis to specialized centers for preoperative examination if therapy with two drugs is ineffective.

Keywords:

stereo-EEG

drug-resistant epilepsy

tuberous sclerosis

multifocal epilepsy

Authors:

Berdinov F.B.

Patrice Lumumba Peoples’ Friendship University of Russia

ORCID: 0000-0001-5314-4436

Levov A.V.

Morozov Children’s Clinical Hospital

ORCID: 0000-0003-3035-9375

Solovev V.B.

Morozov Children’s Clinical Hospital

ORCID: 0000-0003-0024-4630

Kuznetsova A.A.

Solovyov Scientific Practical Psychoneurological Center

ORCID: 0000-0002-0344-9765

Dorofeeva M.Yu.

Veltischev Research Clinical Institute of Pediatrics and Pediatric Surgery

ORCID: 0000-0001-7879-315X

Kislyakov A.N.

Morozov Children’s Clinical Hospital

ORCID: 0000-0001-8735-4909

Umerenkov V.N.

Morozov Children’s Clinical Hospital

ORCID: 0000-0001-7821-0997

Livshits M.I.

Morozov Children’s Clinical Hospital

ORCID: 0000-0001-7010-0101

Chmutin G.E.

Patrice Lumumba Peoples’ Friendship University of Russia

ORCID: 0000-0002-3323-508X

Received:

20.10.2024

Accepted:

28.03.2025

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