When medications are not successful in restraining seizures in children suffering from tuberous sclerosis complex (TSC), an uncommon genetic disorder that seems to impact numerous organ systems and often is the reason for epilepsy, surgery to get rid of fraction of the brain could be required. But pre-surgical testing, which appears to include the implanting of electrodes into a child’s head, may result in longer hospital stays and bigger threats from surgery.
A study from UCLA’s Pediatric Epilepsy Surgery Program has apparently discovered that a different, non-invasive method to pre-surgical testing, along with prior thought for surgery may be linked to the best seizure-free surgical results in patients suffering from TSC.
The study is to initially asses UCLA’s non-invasive technique, which appears to apply a blend of magnetic resonance imaging (MRI), fluoro-deoxyglucose positron emission tomography (FDG-PET) and magnetic source imaging (MSI) to discover the region of brain to be detached. The outcomes appeared to illustrate that about two-thirds of TSC patients apparently turn seizure-free post surgery. The non-invasive results were supposedly akin to the conventional surgical testing process of implanting electrodes into the patient’s head for numerous days of examining.
Lead study author Dr. Joyce Wu, an associate professor of pediatric neurology at Mattel Children’s Hospital at UCLA, commented, “Surgery to remove the portion of the brain causing the epilepsy is the most successful treatment for children with TSC and intractable epilepsy, but mapping which parts to take out can be challenging in a disease with multiple tubers in the brain and therefore multiple potential seizure-generating regions.â€
She added, “The standard test of implanting electrodes into the patient’s head is uncomfortable, leads to a prolonged hospital stay with increased costs, and potentially increases the risks from surgery. Our study looked at the effectiveness of our non-invasive, diagnostic imaging approach, which appeared to work just as well.â€
Study authors also seem to unpredictably discover that shorter seizure period prior to surgery could be linked to the best chance of children with TSC turning seizure-free after surgery. Thereby, it may be vital to consider surgery early, when medications are not successful in controlling seizures.
Around 90 percent of patients suffering from TSC could have epilepsy, with a considerable segment experiencing medication-resistant, or intractable, epilepsy. For these patients, surgical elimination of the tuber and surrounding cerebral cortex could provide seizure freedom.
The study comprised of around 28 TSC patients with intractable epilepsy referred to UCLA between 2000 and 2007. In addition to the average pre-surgical assessments, these patients underwent MSI and FDG-PET/MRI co-registration. Apparently, nobody went through the invasive intracranial test. Of these patients, around 18 experienced surgical resection, and of those, 12 appeared to be seizure-free postoperatively with a standard follow up of 4.1 years.
The study also established that a younger age at surgery and shorter seizure duration is said to be linked to post-operative freedom of seizures. As epilepsy in children could be acutely incapacitating, early diagnosis and treatment may be crucial in aiding a child attain complete cognitive potential.
The subsequent phase of stage is all set to concentrate on using this method towards non-TSC patients.
The study will appear in Neurology, the medical journal of the American Academy of Neurology.