Surgical treatment of epilepsy associated with tuberous sclerosis in children: a single-center retrospective study

Background. The most common symptom of CNS damage in tuberous sclerosis is epilepsy. The last one is drug-resistant in most cases. Surgical treatment should be considered in these patients. Objective. To analyze the results of surgical treatment of drug-resistant epilepsy in children with tuberous sclerosis, to identify predictors of successful treatment. Material and methods. A retrospective study included 45 children between 2017 and 2023. In addition to standard non-invasive procedures, preoperative management included stereo-EEG in 19 cases, subdural EEG in 2 cases and staged subdural and stereo-EEG in 1 case. Selective tuberectomy was performed in 15 patients, tuberectomy (+) — in 16 children, lobectomy — in 6, multilobar resection — in 4, posterior quadrant disconnection — in 2, hemisphrotomy — in 2, repeated surgeries — in 6 children. Results. The median follow-up was 27 months. Postoperative outcomes ILAE grade I, IV, V and VI were observed in 62%, 25%, 11% and 2% of cases, respectively. Antiepileptic therapy was discontinued in 4.4% of cases. In 22.2% of patients, doses of drugs were reduced. Epileptogenic zone in frontal lobe favorably affected postoperative outcome (p=0.027). Transient hemiparesis occurred in 5 (11.1%) cases, persistent expected hemiparesis — in 1 (2.2%) case. Conclusion. Surgical treatment is effective for epilepsy in children with tuberous sclerosis. It is advisable to refer children with epilepsy and tuberous sclerosis to specialized centers for preoperative examination if therapy with two drugs is ineffective. © 2025 Elsevier B.V., All rights reserved.