Which cortical tuber type is more epileptogenic? Magnetic resonance imaging-based study in children with tuberous sclerosis complex

Abstract

Background Cortical tubers are the most common brain lesions in patients with tuberous sclerosis complex (TSC). The relationship between cortical tubers and the severity of seizures is challenging and still not totally understood. Purpose The aim was to identify the different types of cortical tubers in children with TSC on the basis of MRI and to evaluate the relationship between these tuber types and severity of epilepsy. Participants and methods Twenty children with a history of TSC and neurological manifestations, mainly epilepsy, were enrolled in this prospective study. All patients were examined by conventional MRI imaging including 3D T1, axial T2, axial fluid-attenuated inversion-recovery (FLAIR), diffusion-weighted imaging, and susceptibility-weighted imaging. Characterization of different types of tubers was performed on the basis of the signal intensity of their subcortical white matter. The association between the severity of epilepsy and types of cortical tubers was studied. Results Four types of cortical tubers were identified labeled A, B, C, and D. Type A was only identified on T2 and FLAIR. Type B showed a hypointense T1 signal with hyperintensity on T2 and FLAIR. Type C was cystic, with the highest apparent diffusion coefficient values. Type D was calcified with blooming on susceptibility-weighted imaging. Patients were grouped into 4 groups according to the tuber types. There was a significant difference between different groups and frequency of seizures (P Conclusions Cortical tubers can be classified into different types on the basis of their MRI signal intensities. Identification of these types is a valuable noninvasive diagnostic measurement in the assessment of the severity of seizures in TSC patients, which may help in tailoring the treatment for each patient.