Two or more years after the operations, 17 of the 25 children were free of seizures or had only mild non-disabling attacks. Six children still experienced more severe non-disabling seizures but the number of such seizures was reduced by more than 90 percent. In two children the number was reduced by 50 percent to 90 percent. Despite the risks of brain surgery, Dr. Weiner and his colleagues report that the multiple surgeries did not cause serious infections or permanent damage to the brain.
"At some centers multiple-stage surgery would be considered aggressive, but we have established that this type of surgery is safe," says Dr. Weiner. "Certainly this type of surgery should only be reserved for the toughest cases--children with tuberous sclerosis who are having uncontrolled seizures in association with developmental delay or even regression."
Tuberous sclerosis produces tubers on many organs in the body, including the skin, kidneys, lungs, and eyes. In the brain, the hard calcified growths cause seizures. Mental retardation, autism, and other developmental problems can occur in as many as two-thirds of individuals with the disease, according to the National Institute of Neurological Disorders and Stroke. Children with tuberous sclerosis typically have more than two tubers but some may have up to 20 in their brain, says Dr. Weiner.
Many children with the disease aren't usually considered candidates for brain surgery because it is difficult to identify which tubers are causing seizures using electroencephalography (EEG), which records electrical activity in the brain through electrodes placed on the scalp. The seizures in these children are spreading so quickly that by the time the electrodes pick up the abnormal nerve firings, it is no longer possible to determine where they originated. Other noninvasive imaging techniques
Contact: Jennifer Choi
New York University Medical Center and School of Medicine