Clinical characteristics and post-surgical outcomes of focal cortical dysplasia subtypes

Object The long-term surgical outcome of pediatric patients with epilepsy accompanied by focal cortical dysplasia (FCD) is not clear. The authors report on the long-term surgical outcomes of children with FCD, based on longitudinal analyses. Methods The authors retrospectively analyzed the records of 41 children who underwent epilepsy surgery for pathologically proven FCD. Twenty of these patients were male and 21 were female. The median age at surgery was 9 years (range 1–17 years). Results The actuarial seizure-free rates were 49, 44, and 33% in the 1st, 2nd, and 5th years after surgery, respectively. There was no seizure recurrence after 3 years. Three patients with initial failure of seizure control experienced late remission of seizures (the so-called running-down phenomenon). Eventually, 19 patients (46%) were seizure free at their last follow-up visit. Absence of a lesion on MR imaging and incomplete resection were significantly associated with seizure-control failure. Concordance of presurgical evaluation data was a marginally significant variable for seizure control in patients with lesional epilepsy. Three patients with seizure-control failure became seizure free as a result of the running-down phenomenon. The actuarial rate of antiepileptic drug discontinuation was 91% in the 5th year in the seizure-free patients. Conclusions The seizure-free rate after surgery in children with FCD was 49% in the 1st year; however, it declined thereafter. The running-down phenomenon could be an important mechanism of seizure alleviation for patients with FCD during long-term follow-up. Because a complete resection of FCD has a strong prognostic implication for seizure control, a better method to define the extent of FCD is required to assist with resection, especially in nonlesional epilepsy.

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Side of Lesions Predicts Surgical Outcomes in Patients With Drug-Resistant Temporal Lobe Epilepsy Secondary to Focal Cortical Dysplasia Type IIIa

Frontiers in Neurology ◽

10.3389/fneur.2020.580221 ◽

2020 ◽

Vol 11 ◽

Author(s):

Xinghui He ◽

Dingyang Liu ◽

Zhuanyi Yang ◽

Junmei Zhang ◽

Sushan Li ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Surgical Outcomes ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Seizure Freedom ◽

Drug Resistant ◽

Type Iiia ◽

Postoperative Seizure ◽

The Right

Objective: This study aims to evaluate the surgical outcomes and analyze the predictors of surgical outcomes in patients undergoing anterior temporal lobectomy (ATL) for drug-resistant temporal lobe epilepsy (TLE) secondary to focal cortical dysplasia (FCD) type IIIa.Methods: Data on patients with drug-resistant TLE secondary to FCD type IIIa who had undergone ATL at Xiangya Hospital, Central South University from January 2014 to April 2018, were collected retrospectively. International League Against Epilepsy (ILAE) classification was used to evaluate postoperative seizure outcomes. Predictors of surgical outcomes were identified by using univariate and multivariate analyses.Results: A total of 43 patients with drug-resistant TLE secondary to FCD type IIIa who had undergone ATL were included in this study. Twenty patients had right ATL, and 23 patients had left ATL. With a follow-up of 2–6 years, 76.7% (33 of 43) of patients were seizure-free. Univariate and multivariate analysis results indicated that lesions on the right side independently predict postoperative seizure freedom (OR, 0.08; 95% CI, 0.01–0.72; P = 0.024).Conclusion: ATL is an effective therapy for patients with drug-resistant TLE secondary to FCD type IIIa. Patients with lesions on the right side are more likely to achieve postoperative seizure freedom.

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Surgical outcomes in two different age groups with Focal Cortical Dysplasia type II: Any real difference?

Epilepsy & Behavior ◽

10.1016/j.yebeh.2017.02.031 ◽

2017 ◽

Vol 70 ◽

pp. 45-49 ◽

Cited By ~ 10

Author(s):

Jorge Luis Ramírez-Molina ◽

Roberta Di Giacomo ◽

Valeria Mariani ◽

Francesco Deleo ◽

Francesco Cardinale ◽

...

Keyword(s):

Surgical Outcomes ◽

Focal Cortical Dysplasia ◽

Age Groups ◽

Cortical Dysplasia ◽

Type Ii ◽

Real Difference

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Surgical outcome and prognostic factors in epilepsy patients with MR-negative focal cortical dysplasia

PLoS ONE ◽

10.1371/journal.pone.0249929 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249929

Author(s):

Min Jae Seong ◽

Su Jung Choi ◽

Eun Yeon Joo ◽

Young-Min Shon ◽

Dae-Won Seo ◽

...

Keyword(s):

Prognostic Factors ◽

Surgical Outcomes ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Type I ◽

Epileptiform Discharges ◽

Interictal Epileptiform Discharges ◽

Neuroimaging Data ◽

Magnetic Resonance Imaging Mri ◽

Drug Resistant Epilepsy

Objective Focal cortical dysplasia (FCD) represents a heterogeneous group of disorders of the cortical formation and is one of the most common causes of epilepsy. Magnetic resonance imaging (MRI) is the modality of choice for detecting structural lesions, and the surgical prognosis in patients with MR lesions is favorable. However, the surgical prognosis of patients with MR-negative FCD is unknown. We aimed to evaluate the long-term surgical outcomes and prognostic factors in MR-negative FCD patients through comprehensive presurgical data. Methods We retrospectively reviewed data from 719 drug-resistant epilepsy patients who underwent resective surgery and selected cases in which surgical specimens were pathologically confirmed as FCD Type I or II. If the epileptogenic focus and surgical specimens were obtained from brain areas with a normal MRI appearance, they were classified as MR-negative FCD. Surgical outcomes were evaluated at 2 and 5 years, and clinical, neurophysiological, and neuroimaging data of MR-negative FCD were compared to those of MR-positive FCD. Results Finally, 47 MR-negative and 34 MR-positive FCD patients were enrolled in the study. The seizure-free rate after surgery (Engel classification I) at postoperative 2 year was 59.5% and 64.7% in the MR-negative and positive FCD groups, respectively (p = 0.81). This rate decreased to 57.5% and 44.4% in the MR-negative and positive FCD groups (p = 0.43) at postoperative 5 years. MR-negative FCD showed a higher proportion of FCD type I (87.2% vs. 50.0%, p = 0.001) than MR-positive FCD. Unilobar cerebral perfusion distribution (odds ratio, OR 5.41) and concordance of interictal epileptiform discharges (OR 5.10) were significantly associated with good surgical outcomes in MR-negative FCD. Conclusion In this study, MR-negative and positive FCD patients had a comparable surgical prognosis, suggesting that comprehensive presurgical evaluations, including multimodal neuroimaging studies, are crucial for obtaining excellent surgical outcomes even in epilepsy patients with MR-negative FCD.

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