AP-10 Outcome of Epilepsy Surgery in Tuberous Sclerosis Patients

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Introduction: Tuberous sclerosis complex (TSC) is a multisystem, autosomal dominant neurocutaneous syndrome. Epilepsy occurs in 80 to 90% of patients and over 50% of patients suffer from drug resistant epilepsy (DRE). Aim: To describe characteristics of DRE in TSC patients. To determine predictive factors in surgical outcomes of TSC patients. Materials and Methods: This retrospective observational study included thirty-three patients of TSC admitted to Epilepsy monitoring unit between 2015 and 2022. Patients clinical details, developmental status, MRI, 1-year postsurgical outcome status was recorded. Results: Median age at presentation, median age at seizure onset, and median duration of epilepsy at presentation were 4.4 years, 6 months, and 3.7 years, respectively. Seizure onset below 2 years of age predicted delayed development. Out of 33 patients 23 had focal seizures, 6 had spasms, 4 had multiple seizure types with predominant tonic seizures, and one had only tonic seizures. On EEG interictal discharges were multifocal in 19, focal in 13, and generalized in 1 patient. Out of 29 patients, 5 had polymorphic seizures in the form of diffuse-onset ictal rhythm in addition to focal onset, 12 had diffuse onset, and 11 had focal onset ictal rhythm.14 patients underwent surgery, out of which 12 had tuber resection and 2 had corpus callosotomy. Engel class Ia was seen in 58.3% (7/12). All the patients with Engel Ia outcome had unifocal ictal rhythm on EEG. Presence of spasms, multifocal interictal epileptiform activity, and diffuse onset ictal rhythms were associated with a poor postoperative seizure outcome. Conclusion: Epilepsy surgery is an important treatment option for patients of TSC with medically intractable epilepsy. Publication History Article published online: 12 September 2024 © 2023. Indian Epilepsy Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

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