Microscopic mild focal cortical dysplasia in temporal lobe dual pathology: An electrocorticography study

Purpose The results of surgery in patients with mesial temporal lobe epilepsy (MTLE) associated with hippocampal sclerosis (HS) are favorable, with a success rate over 70% following resection. An association of HS with focal cortical dysplasia (FCD) in the temporal lobe is one of the potential causes for poor surgical outcome in MTLE. We aimed to analyzed seizure outcome in a population of MTLE patients and recognize the role of occult FCD in achieving postoperative seizure control. Methods We retrospectively analyzed postoperative outcomes for 82 consecutive adult patients with the syndrome of MTLE due to HS, who had no concomitant lesions within temporal lobe in MRI and who underwent surgical treatment in the years 2005–2016, and correlated factors associated with seizure relapse. Results At the latest follow-up evaluation after surgery, 59 (72%) were free of disabling seizures (Engel Class I) and 48 (58,5%) had an Engel Class Ia. HS associated with FCD in neocortical structures were noted in 33 patients (40%). Analyzes have shown that dual pathology was the most significant negative predictive factor for Engel class I and Engel class Ia outcome. Conclusions The incidence of dual pathology in patients with temporal lobe epilepsy seems to be underestimated. An incomplete epileptogenic zone resection of occult focal temporal dysplasia within temporal lobe is supposed to be the most important negative prognostic factor for seizure freedom after epilepsy surgery in MTLE-HS patients. The study indicates the need to improve diagnostics for other temporal lobe pathologies, despite the typical clinical and radiological picture of MTLE-HS.

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Focal Cortical Dysplasia in Temporal Lobe Epilepsy

Magnetic Resonance Scanning and Epilepsy ◽

10.1007/978-1-4615-2546-2_20 ◽

1994 ◽

pp. 111-116

Author(s):

R. Kuzniecky

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia

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Neuropathology of Temporal Lobe Epilepsy

Epilepsy Research and Treatment ◽

10.1155/2012/624519 ◽

2012 ◽

Vol 2012 ◽

pp. 1-13 ◽

Cited By ~ 6

Author(s):

Fahd Al Sufiani ◽

Lee Cyn Ang

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Wide Range ◽

Pathologic Findings ◽

Pathologic Lesions ◽

Recent Classification ◽

Associated Tumors

Pathologic findings in surgical resections from patients with temporal lobe epilepsy include a wide range of diagnostic possibilities that can be categorized into different groups on the basis of etiology. This paper outlines the various pathologic entities described in temporal lobe epilepsy, including some newly recognized epilepsy-associated tumors, and briefly touch on the recent classification of focal cortical dysplasia. This classification takes into account coexistent pathologic lesions in focal cortical dysplasia.

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Dual Pathology in Rasmussen’s Encephalitis: A Report of Coexistent Focal Cortical Dysplasia and Review of the Literature

Case Reports in Pathology ◽

10.1155/2012/569170 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Richard A. Prayson

Keyword(s):

Chronic Inflammation ◽

Focal Cortical Dysplasia ◽

Intractable Epilepsy ◽

Cortical Dysplasia ◽

Cortical Atrophy ◽

Review Of The Literature ◽

Dual Pathology ◽

Rasmussen’S Encephalitis ◽

Intractable Seizures

Rasmussen’s encephalitis is a well-established, albeit rare cause of medically intractable epilepsy. In a small number of Rasmussen's cases, a second pathology is identified, which independently can cause medically intractable seizures (dual pathology). This paper documents a case of a 13-year-old male who presented with medically intractable epilepsy. The patient underwent a series of surgical resections, early on resulting in a diagnosis of focal cortical dysplasia and later yielding a diagnosis of coexistent Rasmussen’s encephalitis, marked by chronic inflammation, microglial nodules, and focal cortical atrophy, combined with focal cortical dysplasia (Palmini et al. type IIA, ILAE type IIA). The literature on dual pathology in the setting of Rasmussen’s encephalitis is reviewed.

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Epileptogenicity of cortical dysplasia in temporal lobe dual pathology: an electrophysiological study with invasive recordings

Brain ◽

10.1093/brain/awh687 ◽

2005 ◽

Vol 129 (1) ◽

pp. 82-95 ◽

Cited By ~ 73

Author(s):

Susanne Fauser ◽

Andreas Schulze-Bonhage

Keyword(s):

Temporal Lobe ◽

Electrophysiological Study ◽

Cortical Dysplasia ◽

Dual Pathology

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Temporal lobe epilepsy and focal cortical dysplasia in children: A tip to find the abnormality

Epilepsia ◽

10.1111/epi.13615 ◽

2016 ◽

Vol 58 (1) ◽

pp. 113-122 ◽

Cited By ~ 12

Author(s):

Luca Bartolini ◽

Matthew T. Whitehead ◽

Cheng-Ying Ho ◽

Leigh N. Sepeta ◽

Chima O. Oluigbo ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia

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Temporal lobe epilepsy associated with 'triple pathology' of hippocampal sclerosis, focal cortical dysplasia and cavernoma in the ipsilateral frontal lobe

Epilepsy & Seizure ◽

10.3805/eands.2.34 ◽

2009 ◽

Vol 2 (1) ◽

pp. 34-41 ◽

Cited By ~ 4

Author(s):

Kazuhiro Samura ◽

Takato Morioka ◽

Kimiaki Hashiguchi ◽

Yasushi Miyagi ◽

Hiroshi Shigeto ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Frontal Lobe ◽

Temporal Lobe ◽

Focal Cortical Dysplasia ◽

Hippocampal Sclerosis ◽

Cortical Dysplasia

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Principles of Invasive EEG

Invasive Studies of the Human Epileptic Brain ◽

10.1093/med/9780198714668.003.0002 ◽

2018 ◽

pp. 19-25

Author(s):

Samden D. Lhatoo ◽

Nuria Lacuey ◽

Philippe Ryvlin

Keyword(s):

Temporal Lobe ◽

Epilepsy Surgery ◽

Focal Epilepsy ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Palliative Surgery ◽

Mesial Temporal Sclerosis ◽

Choice Of Technique ◽

Inappropriate Choice

The growing requirement for invasive EEG in presurgical evaluation of intractable focal epilepsy has been driven largely by the increasing complexity of epilepsy surgery cases. Extratemporal surgeries now exceed anterior temporal lobe resections for mesial temporal sclerosis, and the proportion of patients undergoing invasive EEGs has significantly increased. Half of all patients undergoing stereotactic EEG (SEEG) evaluations are MRI-negative (usually with focal cortical dysplasia type 1 or 2) and a third are reoperations for failed resective or palliative surgery. Certain principles guide the decision to use invasive EEG and the choice of invasive EEG technique. SEEG has distinct advantages, as do subdural grid evaluations and intraoperative corticography. The consequences of loose hypotheses in the decision to invasively evaluate a patient, and of inappropriate choice of technique, include poor seizure outcomes after surgery, morbidity, and mortality. This chapter discusses the guiding principles for invasive studies of the human epileptic brain.

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