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Surgery for drug-resistant tuberous sclerosis complex-associated epilepsy: who, when, and what Volume 23, numéro 1, February 2021

TEST YOURSELF

(1) Is epilepsy in patients with tuberous sclerosis surgical remediable?

 

(2) How can SEEG help in delineating the epileptogenic zone?

 

(3) Which is the best surgical approach?

 

 

 

 

 

 

 

 

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Answers

(1) Not every patient can undergo surgery. Pre-surgical work-up can help in defining the best candidate. Despite the fact that non-invasive pre-surgical work-up may be of significant benefit, MRI and Video-EEG findings, up to now, are not completely reliable, therefore most patients may need invasive recordings.

 

(2) Invasive recordings and SEEG reveal that the epileptogenic zone may be centered in the tuber in some patients. In such cases, tuberectomy may lead to a seizure freedom rate of 80%. For the remaining patients,the organization of the epileptogenic zone is more complex with a clear reduction in post-surgical seizure freedom rate (40%).

 

(3) In the largest published study (Liu et al., 2020), tuberectomy with perituberal resection and lobectomy, seems to be superior to tuberectomy alone.

 

 

 

 

 

 

 

 

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