Abstracts

In patients with Tuberous Sclerosis Complex (TSC), 80-90% have seizures, many of which are difficult to control. For some, surgery is a treatment option. Due to multi-focality in most of these children, becoming seizure free is not an expectation for most. Children are thought to be good surgical candidates if there is an expectation of a reduction in seizure frequency and severity, and improvement in functioning. This expectation is based on the fact that their EEGs show a focal area being responsible for the majority of their seizures. Charts were reviewed on TSC patients who had EEG/video monitoring between Jan 1995 and Jan 2004. Patients who were thought to be surgical candidates based upon results from EEG/video monitoring had been presented at the Epilepsy Surgery conference. Other factors taken into consideration included patient/parental desire for surgery, psychiatric and behavioral issues. Records of 65 patients were reviewed. After presentation at the multidisciplinary Epilepsy Surgery conference, 12 patients (18 percent) were thought to be good surgical candidates. In five of these patients, a focal resection was recommended and in the remaining seven patients, Phase II monitoring was recommended. Six of the Phase II patients had subsequent focal resections, and one did not because his seizures could not be well localized. Two of these patients had a hemispherectomy.
Follow-up ranged from six months to nine years. In the six patients with at least one year follow-up, three were seizure free (Engel Class I) and one each were in Class II, III, IV. In patients with Tuberous Sclerosis Complex and intractable seizures, surgery should be considered an option in their treatment plan.