resection of the epileptogenic tubers and epileptogenic foci is successful in the control of seizures in 78% (range 43-100%), and results in reduction of seizure frequency in 20% (10-45%). Quality of life is improved in 95% as a result of seizure control or reduction in medication. Accurate presurgical testing is essential and involves surface videoelectroencephalogram, MRI, positron emission tomography, single-photon emission computed tomography, magnetoencephalography, and invasive EEG

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... ing. Early detection and resection of medically refractory epileptogenic tubers can prevent deterioration of cognitive functioning, improve behavior and socialization, and offer a better qualiy of life. (Romanelli P, Verdecchia M, Rodas R, et al. Epilepsy surgery for tuberous sclerosis. Pediatr Neurol 2004;31:239-247). (Respond: Dr Paolo Curatolo, Pediatric Neurology, University of Rome "Tor Vergata,"V le Oxford 81, 00133, Rome, Italy). COMMENT. Early effective seizure control may significantly reduce the adverse effects on cognition and development associated with refractory recurrent seizures in tuberous sclerosis. With new presurgical investigative techniques, it is now possible to select patients who may be amenable to resection of multiple epileptogenic tubers. In patients not suitable for resection, anterior callosotomy, vagal nerve stimulation, and radiosurgery are alternative methods suggested.