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Bilateral invasive electroencephalography in patients with tuberous sclerosis complex: a path to surgery? J Neurosurg Pediatr 2011 Apr;7(4):421-30

Date

04/05/2011

Pubmed ID

21456917

DOI

10.3171/2011.1.PEDS10348

Scopus ID

2-s2.0-79953831830   30 Citations

Abstract

OBJECT: Many children with epilepsy and tuberous sclerosis complex (TSC) have multiple tubers on MR imaging and poorly localized/lateralized video electroencephalography (EEG) findings. Given the long-term risks associated with frequent seizures and multiple antiepileptic drugs, along with improved success in identifying focal epileptogenic zones in patients with multifocal lesions, the authors used bilateral intracranial EEG to lateralize the epileptogenic zone in patients with nonlateralizable noninvasive preoperative evaluations.

METHODS: A retrospective analysis from January 1, 1998, to June 30, 2008, identified 62 children with TSC who were presented at a surgical conference. Of the 52 patients undergoing diagnostic or therapeutic procedures during the study period, 20 underwent bilateral intracranial EEG. The presurgical testing results, intracranial EEG findings, surgical interventions, and outcomes were reviewed.

RESULTS: Fourteen of 20 patients had intracranial EEG findings consistent with a resectable epileptogenic zone. One patient is awaiting further resection. Five patients had findings consistent with a nonresectable epileptogenic zone, and 1 of these patients underwent a callosotomy. Seven patients had Engel Class I outcomes, 1 was Class II, 3 were Class III, and 3 were Class IV (mean follow-up 25 months).

CONCLUSIONS: Bilateral intracranial EEG can identify potential resectable seizure foci in nonlateralizable epilepsy in TSC. Although 6 of 20 patients did not undergo resection (1 patient is pending future resection), significant improvements in seizures (Engel Class I or II) were noted in 8 patients. In the authors' experience, this invasive monitoring provided a safe method for identifying the ictal onset zone.

Author List

Carlson C, Teutonico F, Elliott RE, Moshel YA, LaJoie J, Miles D, Devinsky O, Weiner HL

Author

Chad Carlson MD Professor in the Neurology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Anticonvulsants
Attention Deficit Disorder with Hyperactivity
Child
Child, Preschool
Drug Resistance
Electrodes, Implanted
Electroencephalography
Epilepsy
Female
Functional Laterality
Humans
Infant
Magnetoencephalography
Male
Neurosurgical Procedures
Positron-Emission Tomography
Seizures
Tomography, Emission-Computed, Single-Photon
Treatment Outcome
Tuberous Sclerosis