Identification of candidates for epilepsy surgery in patients with tuberous sclerosis

The authors reviewed preoperative MRI and EEG findings in relation to postsurgical outcome in 17 patients with refractory epilepsy due to tuberous sclerosis complex (TSC). Resecting concordant MRI (main tuber) and EEG abnormalities offered seizure freedom (8/9, 89%; median follow-up 25 months) comparable to other focal etiologies. Patients with nonconcordant MRI and EEG findings did less well (3/8, 38%, seizure free; p = 0.027, OR = 13).

[Extrapulmonary tuberculosis]

Although the respiratory tract is the major site for tuberculous lesions, all organs can be affected. The authors review the clinical files of 25 patients admitted to our Department with lung and/or pleural tuberculous disease, confirmed by bacteriology or histopathology, who simultaneously suffered from tuberculosis in other organs. We included 20 men and 5 women, aged from 10 to 74 years (mean: 37.12 years); 6 patients had pleural tuberculosis, 19 had pulmonary tuberculosis, 4 of them having miliary tuberculosis. Lymph node tuberculosis was diagnosed in 14 patients, tuberculosis of the bones in 4, laryngeal tuberculosis in 3 patients, tuberculous pericarditis in 2 patients, epididymitis in 1 and intestinal in another patient. Several clinical aspects are discussed, namely diagnostic procedures, M. tuberculosis identification in inflammatory exudates in 6 patients, in urine in 1, and in histopathology in 9 patients; in the 9 remaining patients extrapulmonary tuberculosis was accepted considering clinical and radiological findings in patients with respiratory tract tuberculosis. We concluded that tuberculosis may still assume severe clinical forms and that patients with tuberculosis should be globally evaluated.