Epilepsy Surgery- Tuberous Sclerosis Complex

Overview

Bhabik was experiencing seizures since birth, often more than 50  times daily.

This 6-week-old baby was referred to the Paediatric Neurology  Department of SRCC Children’s Hospital, managed by Narayana  Health, from Nasik when multiple anti-seizure medications became ineffective in controlling the daily episodes of numerous seizures.

After having a thorough clinical investigation followed by MRI scans, EEG  and ECHO, the paediatric epileptologist arrived at a diagnosis of Tuberous Sclerosis Complex.

She recommended administering vigabatrin, a precision treatment for epilepsy associated with TSC. But seizures continued. Moreover,  Bhabik started showing signs of developmental delay.

When the paediatric neurologists went for further investigation and studied the pattern and the signs of the seizure, the semiologist suggested that the seizures originated from the large tuber in the infant’s brain. A 24-hour video EEG monitoring confirmed the same along with the previous hypothesis that Bhabik had surgically remediable epilepsy.

The next challenge was this tuber’s location on the right lobe, which controls movements of the entire left side of the body.  Given the small age, most functional tests could not be performed to understand how much motor function was being controlled from the tuber.

The surgery to attempt was complex and difficult from multiple perspectives –

• • Location of the tuber 
  • Very young age (7 months) 
  • Weight of the child 

The risk of paralysis post-surgery was even weighed against the poor seizure freedom in case of incomplete removal of the tuber. After discussing with the parents, a decision was taken to favour the surgery. A team of paediatric neurosurgeons and neurologists performed a resective epilepsy surgery with multiple intraoperative monitoring tests –  ECoG for seizures, MEPs for motor function, brain ultrasonogram and neuronavigation guidance, among others.

These tests were crucial to define the area causing seizures from the area controlling motor function.  The surgery was performed over 6  long hours. The baby was admitted to  PICU postoperatively for a day for neuroprotection.

The surgery was successful, and the child is now SEIZURE-FREE, down to  0 seizures a day from 50 plus seizures a day. Bhabik had minimal transient paralysis, which improved even before hospital discharge. Postoperative EEG was also normal. His interactive response improved. He started looking and smiling. Now, the team plans to start working on neurodevelopment – using the  precious window of opportunity given by the seizure freedom for his brain to develop skills such as walking, speech, etc.

Appointments Emergencies 1A, Haji Ali Park, Mahalaxmi, Mumbai 1800-309-0309 022-71222333 www.narayanahealth.org