Epilepsy is one of the main symptoms affecting the lives of individuals with tuberous sclerosis complex (
TSC), causing a high rate of morbidity. Individuals with
TSC can present with various types of
seizures,
epilepsies, and
epilepsy syndromes that can coexist or appear in relation to age.
Focal epilepsy is the most frequent
epilepsy type with two developmental and epileptic
encephalopathies:
infantile spasms syndrome and
Lennox-Gastaut syndrome. Active screening and early management of
epilepsy is recommended in individuals with
TSC to limit its consequences and its impact on quality of life, cognitive outcome and the economic burden of the disease. The progress in the knowledge of the mechanisms underlying
epilepsy in
TSC has paved the way for new concepts in the management of
epilepsy related to
TSC. In addition, we are moving from traditional "reactive" and therapeutic choices with current antiseizure medications used after the onset of
seizures, to a proactive approach, aimed at predicting and preventing epileptogenesis and the onset of
epilepsy with
vigabatrin, and to personalized treatments with mechanistic
therapies, namely mechanistic/
mammalian target of rapamycin inhibitors. Indeed,
epilepsy linked to
TSC is one of the only
epilepsies for which a predictive and preventive approach can delay seizure onset and improve seizure response. However, the efficacy of such interventions on long-term cognitive and psychiatric outcomes is still under investigation.