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TSC – Everolimus for Seizures — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersTSC – Everolimus for SeizuresSCE Neurology

A 30-year-old man with tuberous sclerosis complex (TSC) has drug-resistant focal epilepsy. His seizures are arising from a cortical tuber in the right temporal lobe, confirmed by video-EEG. He has failed 4 antiseizure medications. He is being considered for epilepsy surgery. In addition to resective surgery, what TSC-specific medication may help reduce seizure frequency?

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Correct answer: A — Everolimus

Everolimus (an mTOR inhibitor) has been approved for the treatment of refractory seizures associated with TSC (EXIST-3 trial). TSC is caused by mutations in TSC1 or TSC2, leading to overactivation of the mTOR pathway. Everolimus directly targets this pathological mechanism. It can reduce seizure frequency in patients who are not surgical candidates or as an adjunct to surgery. A: Temozolomide is for gliomas. C: Sirolimus (rapamycin) is a related mTOR inhibitor used for some TSC manifestations but everolimus has the specific seizure indication. D: Bevacizumab is for GBM. E: Cyclophosphamide is for autoimmune/oncological conditions.

Reference: NICE TA687 Everolimus for TSC-related Seizures; EXIST-3 Trial (2016)