Document Detail

Surgical treatment of epilepsy in tuberous sclerosis: strategies and results in 18 patients.
MedLine Citation:
PMID:  9818843     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Seizures in patients with tuberous sclerosis complex (TSC) are often intractable to antiepileptic medications and searching investigation may provide evidence that surgical treatment can be considered. OBJECTIVE: To review the results of investigation and surgical therapy, a treatment modality not generally considered in patients with medically refractory seizures and TSC. METHODS: We report 18 patients (9 male) with TSC who underwent surgical treatment of medically refractory epilepsy. Twelve patients had a well-localized epileptogenic lesion and were treated by lesionectomy or focal resection. Resections were: 7 frontal, 4 temporal, 1 frontotemporal, 1 occipital, and 1 frontoparietal. Four patients underwent more than one operation. Six patients had corpus callosotomy (CC). RESULTS: Follow-up ranged from 1 month to 47 years. Outcome of the patients treated by resection was excellent in 7 (5 were seizure-free and 2 had auras only), good in 1, fair in 3, and 1 was lost to follow-up. Best outcome was obtained in patients who had focal seizures and good imaging and EEG correlation, although they might have multiple seizure types, other imaging abnormalities, and multifocal or generalized EEG findings. When there was no such correlation, CC was found to be an option as five patients had at least some improvement and only one showed no change. CONCLUSION: Surgical treatment of patients with TSC and intractable epilepsy is most effective when a single tuber or epileptogenic area can be identified as the source of seizures and resected. This may be possible even when other tubers or diffuse EEG abnormalities are present. In patients with unlocalizable epileptic abnormalities, palliation may be obtained by CC.
M M Guerreiro; F Andermann; E Andermann; A Palmini; P Hwang; H J Hoffman; H Otsubo; A Bastos; F Dubeau; G J Snipes; A Olivier; T Rasmussen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurology     Volume:  51     ISSN:  0028-3878     ISO Abbreviation:  Neurology     Publication Date:  1998 Nov 
Date Detail:
Created Date:  1998-12-03     Completed Date:  1998-12-03     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1263-9     Citation Subset:  AIM; IM    
Department of Neurology and Neurosurgery, and Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada.
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MeSH Terms
Age of Onset
Brain / pathology
Child, Preschool
Epilepsy / complications*,  surgery*
Follow-Up Studies
Magnetic Resonance Imaging
Middle Aged
Retrospective Studies
Time Factors
Treatment Outcome
Tuberous Sclerosis / complications*,  surgery*

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