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UDK: 616.8 DOI:10.33920/med-01-2403-01

Stereoelectroencephalography and surgical treatment of TSC-associated epilepsy in children: preliminary results

Berdinov Farkhad Bakhramdzhanovich neurosurgeon, SBHI Morozov Children's City Clinical Hospital of the Moscow Healthcare Department (1/9, 4-y Dobryninskiy lane, Moscow, 119049, Russia), PhD student, Department of Nervous Diseases and Neurosurgery, Medical Institute, Peoples’ Friendship University of Russia (6, Miklukho-Maklaya str., Moscow, Russia), ORCID: https://orcid.org/0000-0001-5314-4436, RSCI: 7496–2026, berdinovns@gmail.com
Levov Aleksandr Vyacheslavovich neurosurgeon, SBHI Morozov Children's City Clinical Hospital of the Moscow Healthcare Department, 1/9, 4-y Dobryninskiy lane, Moscow, 119049, Russia, ORCID: https://orcid.org/0000-0003-3035-9375
Soloviev Vladimir Borisovich neurologist, SBHI Morozov Children's City Clinical Hospital of the Moscow Healthcare Department, 1/9, 4-y Dobryninskiy lane, Moscow, 119049, Russia, ORCID: https://orcid.org/0000-0003-0024-4630
Shchederkina Inna Olegovna PhD Candidate in Medicine, neurologist, SBHI Morozov Children's City Clinical Hospital of the Moscow Healthcare Department, 1/9, 4-y Dobryninskiy lane, Moscow, 119049, Russia, ORCID: https://orcid.org/0000-0002-2302-1205
Kuznetsova Aleksandra Andreevna neurologist, SBHI Morozov Children's City Clinical Hospital of the Moscow Healthcare Department (1/9, 4-y Dobryninskiy lane, Moscow, 119049, Russia), Moscow Research and Clinical Center for Neuropsychiatry of the Moscow Healthcare Department (43, Donskaya str., Moscow, 115419, Russia), ORCID: https://orcid.org/0000-0002-0344-9765
Russkin Vadim Olegovich neurologist, FSBSI Petrovsky National Research Center of Surgery (2, Abrikosovskiy lane, Moscow, 119435), SBHI Morozov Children's City Clinical Hospital of the Moscow Healthcare Department (1/9, 4-y Dobryninskiy lane, Moscow, 119049, Russia), ORCID: https://orcid.org/0000-0003-4743-5522
Umerenkov Viktor Nikolaevich neurosurgeon, SBHI Morozov Children's City Clinical Hospital of the Moscow Healthcare Department, 1/9, 4-y Dobryninskiy lane, Moscow, 119049, Russia, ORCID: https://orcid.org/0000-0001-7821-0997
Livshits Matvey Igorevich PhD Candidate in Medicine, neurosurgeon, SBHI Morozov Children's City Clinical Hospital of the Moscow Healthcare Department (1/9, 4-y Dobryninskiy lane, Moscow, 119049, Russia), FSAEI HE Peoples’ Friendship University of Russia (6, Miklukho-Maklaya str., Moscow, 117198, Russia), ORCID: https://orcid.org/0000-0001-7010-0101
Chmutin Gennadiy Egorovich PhD in Medicine, neurosurgeon, head of the Department of Nervous Diseases and Neurosurgery, Medical Institute, Peoples' Friendship University of Russia, 6, Miklukho-Maklaya str., Moscow, 117198, Russia, ORCID: https:// orcid.org/0000-0002-3323-508X

Introduction. The most prevalent symptom of central nervous system involvement in tuberous sclerosis complex is epilepsy, predominantly of a drug-resistant nature. In such cases, surgical treatment methods become a focal point for consideration. Purpose of the study: to analyze the outcomes of surgical treatment for drug-resistant epilepsy in children with tuberous sclerosis following stereoelectroencephalography. Materials and methods. A retrospective analysis of surgical outcomes for epilepsy in children with tuberous sclerosis after stereo-EEG was conducted. From April 2017 to December 2021, 23 patients underwent prolonged stereo-EEG monitoring. Based on the results of invasive EEG, resective surgery was performed on 14 patients. Primary resection of the epileptogenic zone was carried out in 11 cases (79 %), and repeated resection was performed in 3 cases (21 %). Tuberectomy was conducted in three cases, tuberectomy plus — in six patients, lobectomy — in three patients, multilobar resection — in three cases, and one patient had an extension of the previous resection area with corticoectomy. Results. In the follow-up period ranging from 12 to 78 months, ILAE I outcome was observed in 64 % of cases, ILAE IV in 29 % of children, and ILAE V in 7 % of cases. Antiepileptic therapy was discontinued in one patient, a decrease in drug load was noted in four patients, and an increase in drug load was observed in one patient. Conclusion. Surgical treatment of TSC-associated epilepsy in children requires a comprehensive pre-surgical examination in specialized centers, incorporating the invasive electroencephalography method. Given the multifocal nature of epilepsy, along with the combination of generalized and focal seizures, resective surgery is worth considering as palliative treatment in some cases.

Туберозный склероз (ТС) — аутосомно-доминантное, полиорганное заболевание, характеризуется образованием доброкачественных новообразований (туберов, гамартом) в различных органах. В 75–90 % случаев характерно развитие эпилепсии при поражении ЦНС, которая трудно поддается медикаментозной терапии [1–4]. При фармакорезистентном течении эпилепсии рассматривается вопрос хирургических методов лечения.

На настоящий момент нет общепринятой хирургической тактики лечения эпилепсии у детей с ТС. В различных центрах хирургическая тактика различается, включая одномоментные резекции, интраоперационную электрокортикографию, экстраоперационный инвазивный-ЭЭГ мониторинг с использованием субдуральных и глубинных электродов.

Отбор пациентов

В данное ретроспективное исследование включены дети с фармакорезистентной эпилепсией при туберозном склерозе прошедшие инвазивное предхирургическое обследование с применением глубинных электродов в рамках хирургического лечения эпилепсии на базе нейрохирургического отделения Морозовской ДГКБ в период с 04.2017 по 12.2021 гг. Диагноз туберозный склероз и фармакорезистентная эпилепсия основаны на общепринятых диагностических критериях [5,6].

Предхирургическое обследование

Все пациенты прошли этап неинвазивного обследования, включающий в себя сбор подробного семейного анамнеза и анамнеза заболевания, физикального, неврологического осмотра, МРТ головного мозга по эпилептологическому протоколу, многосуточную скальповую видеоэлектроэнцефалографию (ВЭЭГ). Результаты неинвазивных методов обследований обсуждались на эпилептологическом разборе мультидисциплинарной командой, включающая в себя невролога, эпилептолога, нейрохирурга. Из 42 больных 23 пациента отобраны на инвазивную электроэнцефалографию.

Всем отобранным пациентам проводилось 7 суточный скальповый-ВЭЭГ мониторинг по международной системе установки электродов 10–10 с целью планирования имплантации электродов совместно с данными нейровизуализации. Всем больным, включенным в данное исследование, было принято решение выполнить стерео-ЭЭГ мониторинг.

For citation:
Berdinov Farkhad Bakhramdzhanovich, Levov Aleksandr Vyacheslavovich, Soloviev Vladimir Borisovich, Shchederkina Inna Olegovna, Kuznetsova Aleksandra Andreevna, Russkin Vadim Olegovich, Umerenkov Viktor Nikolaevich, Livshits Matvey Igorevich, Chmutin Gennadiy Egorovich, Stereoelectroencephalography and surgical treatment of TSC-associated epilepsy in children: preliminary results. Bulletin of Neurology, Psychiatry and Neurosurgery. 2024;3.
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