The surgical amenability of epileptogenic lesions in tuberous sclerosis complex is reviewed in the light of novel presurgical assessment in a report by investigators at University of Rome, Italy; Stanford University, Palo Alto, CA; and Central Illinois Neurohealth Sciences, Bloomington, IL, USA. In carefully selected patients, neurosurgical resection of the epileptogenic tubers and epileptogenic foci is successful in the control of seizures in 78% (range 43-100%), and results in reduction of seizure frequency in 20% (10-45%). Quality of life is improved in 95% as a result of seizure control or reduction in medication. Accurate presurgical testing is essential and involves surface video-electroencephalogram, MRI, positron emission tomography, single-photon emission computed tomography, magnetoencephalography, and invasive EEG monitoring. Early detection and resection of medically refractory epileptogenic tubers can prevent deterioration of cognitive functioning, improve behavior and socialization, and offer a better qualiy of life. [1]

COMMENT. Early effective seizure control may significantly reduce the adverse effects on cognition and development associated with refractory recurrent seizures in tuberous sclerosis. With new presurgical investigative techniques, it is now possible to select patients who may be amenable to resection of multiple epileptogenic tubers. In patients not suitable for resection, anterior callosotomy, vagal nerve stimulation, and radiosurgery are alternative methods suggested.