Stereoelectroencephalography and surgical treatment of TSC-associated epilepsy in children: preliminary results

Abstract

Introduction. The most prevalent symptom of central nervous system involvement in tuberous sclerosis complex is epilepsy, predominantly of a drug-resistant nature. In such cases, surgical treatment methods become a focal point for consideration. Purpose of the study: to analyze the outcomes of surgical treatment for drug-resistant epilepsy in children with tuberous sclerosis following stereoelectroencephalography. Materials and methods. A retrospective analysis of surgical outcomes for epilepsy in children with tuberous sclerosis after stereo-EEG was conducted. From April 2017 to December 2021, 23 patients underwent prolonged stereo-EEG monitoring. Based on the results of invasive EEG, resective surgery was performed on 14 patients. Primary resection of the epileptogenic zone was carried out in 11 cases (79 %), and repeated resection was performed in 3 cases (21 %). Tuberectomy was conducted in three cases, tuberectomy plus — in six patients, lobectomy — in three patients, multilobar resection — in three cases, and one patient had an extension of the previous resection area with cor ticoectomy. Results. In the follow-up period ranging from 12 to 78 months, ILAE I outcome was observed in 64 % of cases, ILAE IV in 29 % of children, and ILAE V in 7 % of cases. Antiepileptic therapy was discontinued in one patient, a decrease in drug load was noted in four patients, and an increase in drug load was obser ved in one patient. Conclusion. Surgical treatment of TSC-associated epilepsy in children requires a comprehensive pre-surgical examination in specialized centers, incorporating the invasive electroencephalography method. Given the multifocal nature of epilepsy, along with the combination of generalized and focal seizures, resective surgeryis worth considering as palliative treatment in some cases.