Multifocal Brain Surgery Reduces Epileptic Seizures

A new surgical approach using invasive intracranial monitoring can reduce seizure frequency in children with tuberous sclerosis complex (TSC), according to a new study.

In the study, conducted by researchers from New York University Medical Center (NYU, USA), 25 TSC patients with a median age of four years underwent surgical removal of the tubers. In the first stage of the approach developed by the NYU team, electrodes are placed to identify primary and secondary epileptic foci. In the second stage, these foci are resected. With a third stage, electrodes are reimplanted after resection and any residual foci identified are resected.

Twenty-two of the patients underwent a three-stage surgical approach and three had a two-stage approach. Thirteen of the patients had bilateral electrode placement and 12 had unilateral placement. At six months or longer following surgery, 21 of the children were seizure-free or had only non-disabling simple partial seizures. The remaining children included two who experienced a higher-than-90% drop in seizure frequency and two with a lower-than-50% reduction in frequency. Four of five children who were not originally considered candidates for surgery, due to multiple seizure foci, were rendered seizure-free with the multi-stage approach. The results were reported in the May 2006 issue of Pediatrics.

"This approach can help to identify both primary and secondary epileptogenic zones in young TSC patients with multiple tubers, and may be suitable for some patients with multiple seizure foci,” conclude lead author Dr. Howard L. Weiner and colleagues. "Long-term follow-up will determine whether this approach has durable effects.”

The seizures seen with TSC are usually due to cortical tubers and do not respond to medical therapy. Surgical removal of the tubers, along with the surrounding epileptogenic zone, has shown some promise in reducing seizure frequency, but it is often difficult to define the margins of the zone.



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