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Epilepsy surgery and tuberous sclerosis complex: special considerations. Neurosurg Focus 2008 Sep;25(3):E13

Date

09/02/2008

Pubmed ID

18759614

DOI

10.3171/FOC/2008/25/9/E13

Scopus ID

2-s2.0-56649090957   46 Citations

Abstract

Epilepsy surgery for medically refractory seizures among patients with tuberous sclerosis complex (TSC) is a well-accepted treatment option. Many epilepsy centers around the world have published their experience over the past several years, supporting the idea that the best seizure control is obtained when a single tuber and associated epileptogenic zone is documented and targeted surgically. Recent advances in imaging and physiological techniques that reveal the epileptogenic zone have been used successfully in children with TSC who are being evaluated for surgery. As a result, a number of different surgical strategies have emerged, each reflecting the experience, strengths, and referral biases of the individual treating teams. Experience suggests that some patients with TSC who present with seizures that are difficult to localize and do not meet the classic selection criteria for epilepsy surgery may, nevertheless, benefit from surgery. Tuberectomy alone is often not sufficient for obtaining seizure control. Intracranial electrode recordings performed in a large number of children with TSC undergoing epilepsy surgery have raised new questions about the relationship of the cortical tuber to the epileptogenic zone in TSC. A careful assessment of the risks and benefits of any surgical strategy, compared with those associated with continued refractory epilepsy, should be considered by the treating team in conjunction with the patient's family. Epilepsy surgery has not only benefited many children with TSC, but it also facilitates the understanding of epileptogenesis in TSC.

Author List

Bollo RJ, Kalhorn SP, Carlson C, Haegeli V, 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

Child, Preschool
Epilepsy
Humans
Male
Neurosurgical Procedures
Tuberous Sclerosis