What's going on in the brain of a child with tuberous sclerosis complex?

Dr. Aria Fallah, MD

There are four main findings in the brains of children with tuberous sclerosis complex (TSC).

Cortical dysplasia can occur, meaning that the layers of the brain can be quite disorganized. For whatever reason, that can be very prone to causing epilepsy. In particular, the type of epilepsy that does not respond to medications.

Most children have many tubers all over the brain. For some children, they may just have one. Cortical tubers feel like little potatoes in the brain, and the brain feels like jelly with these little hard nodules. Those are called tubers. Sometimes, they can be calcified and that means they're rock hard or bone hard and can be deposited on the surface of the brain. These are the primary culprits of epilepsy. Doctors try to figure out which one of these multiple tubers is causing the seizures.

Subependymal giant cell astrocytoma (SEGA) tumors are very specific to TSC, and they occur deep inside the brain, usually surrounding the fluid spaces of the brain, which are called the ventricles.

Lastly, there are subependymal nodules. These are small accumulations of cells right around the fluid spaces of the brain. These can also be a cause of seizures. So, it's very important to be very carefully evaluated to see where exactly the seizures may be coming from in a child with TSC.

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