The utility of surveillance EEG to guide early antiepileptic drug therapy in infants with Tuberous Sclerosis Complex

Publication date: Available online 18 April 2017
Source:Pediatric Neurology
Author(s): Robyn Whitney, Saber Jan, Maria Zak, Bláthnaid McCoy
BackgroundSeizures are a common early presentation in infants with Tuberous Sclerosis Complex (TSC) and can be preceded by electrographic changes on electroencephalogram (EEG) prior to clinical seizure onset. There are a limited number of studies that have addressed the initial EEG findings in TSC and the outcome of early treatment with antiepileptic medication prior to clinical seizure onset.MethodsWe report two cases of infants with TSC who had surveillance EEG, which showed focal seizures that were not previously recognized by caregivers. Reference is made to previously reported cases of TSC with early EEG findings in the literature. Both infants were started on vigabatrin after the onset of focal seizures with the aim of preventing seizure recurrence, halting the possible progression to infantile spasms or focal seizures and preventing neurodevelopmental decline. Currently, both cases have remained seizure free and have reached their appropriate developmental milestones.ConclusionWe recommend early serial EEG monitoring once a diagnosis of TSC is suspected or confirmed in infants. Additional prospective studies are needed to assess the long-term outcome of early antiepileptic drug initiation as soon as electrographic seizure activity is detected.



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