Novel surgical protocol helps eliminate seizures for some children with TSC-related epilepsy, reduce medication needs for others
Some children with a form of epilepsy that previously made them poor candidates for surgery are now able to live without seizures, experience drastically reduced seizure episodes and symptoms, or take fewer anti-seizure medications as the result of a novel pre-surgical evaluation protocol developed by researchers in the Pediatric Epilepsy Surgery Program at Cincinnati Children’s.
A research team led by Francesco Mangano, DO, FACS, FACOS, chief of the Division of Pediatric Neurosurgery, studied 37 children who developed epilepsy as a result of tuberous sclerosis complex (TSC), a genetic disorder in which non-malignant tumors form in different organs, including the brain. More than 80 percent of children with TSC develop epilepsy that involves multi-focal brain abnormalities that vary from child to child. Their epilepsy symptoms vary as well.
The study, thought to be the largest single-center study in this pediatric epilepsy population, appeared in the January 2015 issue of the Journal of Neurosurgery: Pediatrics.
Pre-surgery evaluations relied on non-invasive and invasive brain mapping to identify the origin of seizure patterns in each patient. Neurosurgeons then decided which types of resective surgery to pursue – craniotomy to remove tuberous tissue, lobar resections, and even hemispherectomy in some cases.
After five years, 56 percent of the children were seizure-free, and 87 percent had far fewer seizures and significantly less severe seizures, based on a scale developed by the International League Against Epilepsy (ILAE).
“In those children who were not seizure-free, we were able to decrease the number of anti-epileptic drugs needed to continue to control their disease, and we were able to reduce their medication frequencies and doses to improve their side effect profiles,” Mangano says.
