Bilateral resective epilepsy surgery in a child with tuberous sclerosis: Case report

Objective and importance: Surgical intervention can reduce the burden of seizures in selected patients with tuberous sclerosis and medically refractory epilepsy. Clinical presentation: A child presented with tuberous sclerosis and severe epilepsy beginning in the first month of life and delayed development before I year of age. Video-electroencephalographic monitoring at the age of 1 year revealed a left temporal seizure focus. Repeat video-electroencephalography at 2 years of age revealed a right posterior quadrant seizure focus. Bilateral subdural electrodes were placed, confirming independent seizure onsets from the right parietal area (overlying a tuber) and prominent interictal activity over the left superior temporal region. Intervention: The right parietal focus was resected, and electrodes were maintained over the left temporal focus. After right parietal resection, ictal discharges were recorded over the left temporal region; a corticectomy was performed 2 days later. No tonicoclonic or complex partial seizures have occurred during a follow-up period of more than 24 months. Simple partial motor seizures involving the right foot have been reduced by more than 80%, and other simple partial seizures have been eliminated. Postoperatively, there has been marked improvement in the patient's cognitive and motor developmental status. Conclusion: In selected patients with bilateral seizure foci involving separate lobes, aggressive bilateral surgery can be safe and effective.