Epilepsy surgery in tuberous sclerosis.

Tuberous sclerosis (TS) is a multisystemic disease frequently associated wi th a severe drug-resistant partial epilepsy. Nevertheless, the frequent pol ymorphism of ictal clinical features, the extent of the interictal EEG abno rmalities and the disseminated cerebral lesions probably explain why a surg ical treatment is rarely decided with the aim to suppress the seizures. Five patients with TS (including 2 "formes frustes") operated on at Grenobl e Hospital are reported. The age at intervention was comprised between 24 a nd 72 months. In all the patients, seizures started precociously (1-42 mont hs) and were very frequent (2-15 fits a day), clinical semiology has evolve d from the onset of seizures and only one patient presented one kind of sei zure at intervention Interictal scalp EEG showed slow waves and spikes wide ly extended in four patients and unilobar in one. Neuroimaging (CT-scan and MRI) showed calcified lesions in all the patients, multiple in three cases and single in two. A video-EEG monitoring was always performed while a ste reo-EEG investigation was judged necessary in two cases. After the interven tion (lesionectomy associated with a corticectomy irt thr-ee cases, single lesionectomy in the remaining two), all the patients but one are seizure-fr ee (follow-up 34-76 months). These data suggest that, in spite of multiple lesions and widespread EEG abnormalities, the surgical treatment of partial epilepsy in TS may prove to be very usefull in well-selected cases.