Epilepsy Surgery in Children with Focal Cortical Dysplasia (FCD): Results of Long-Term Seizure Outcome

OBJECTIVE Focal cortical dysplasia (FCD) is a common cause of early-onset intractable epilepsy, and resection is a highly sufficient treatment option. In this study, the authors aimed to provide a retrospective analysis of pre- and postoperative factors and their impact on postoperative long-term seizure outcome. METHODS The postoperative seizure outcomes of 50 patients with a mean age of 8 ± 4.49 years and histologically proven FCD type II were retrospectively analyzed. Furthermore, pre- and postoperative predictors of long-term seizure freedom were assessed. The seizure outcome was evaluated based on the International League Against Epilepsy (ILAE) classification. RESULTS Complete resection of FCD according to MRI criteria was achieved in 74% (n = 37) of patients. ILAE class 1 at the last follow-up was achieved in 76% (n = 38) of patients. A reduction of antiepileptic drugs (AEDs) to monotherapy or complete withdrawal was achieved in 60% (n = 30) of patients. Twelve patients (24%) had a late seizure recurrence, 50% (n = 6) of which occurred after reduction of AEDs. A lower number of AEDs prior to surgery significantly predicted a favorable seizure outcome (p = 0.013, HR 7.63). Furthermore, younger age at the time of surgery, shorter duration of epilepsy prior to surgery, and complete resection were positive predictors for long-term seizure freedom. CONCLUSIONS The duration of epilepsy, completeness of resection, number of AEDs prior to surgery, and younger age at the time of surgery served as predictors of postoperative long-term seizure outcome, and, as such, may improve clinical practice when selecting and counseling appropriate candidates for resective epilepsy surgery. The study results also underscored that epilepsy surgery should be considered early in the disease course of pediatric patients with FCD type II.

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Long-term seizure outcome in pediatric patients with focal cortical dysplasia undergoing tailored and standard surgical resections

Seizure ◽

10.1016/j.seizure.2018.09.021 ◽

2018 ◽

Vol 62 ◽

pp. 66-73 ◽

Cited By ~ 6

Author(s):

Eva Martinez-Lizana ◽

Susanne Fauser ◽

Armin Brandt ◽

Elisabeth Schuler ◽

Gert Wiegand ◽

...

Keyword(s):

Pediatric Patients ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Seizure Outcome

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Long-term Seizure Outcome in Reoperation after Failure of Epilepsy Surgery

Neurosurgery ◽

10.1227/01.neu.0000255438.13871.fa ◽

2007 ◽

Vol 60 (5) ◽

pp. 873-880 ◽

Cited By ~ 55

Author(s):

Jorge A. González-Martínez ◽

Teeradej Srikijvilaikul ◽

Dileep Nair ◽

William E. Bingaman

Keyword(s):

Epilepsy Surgery ◽

Intractable Epilepsy ◽

Cortical Dysplasia ◽

Categorical Variables ◽

Seizure Outcome ◽

Mesial Temporal Sclerosis ◽

Long Term Outcome ◽

The Relationship

Abstract OBJECTIVE Treatment of patients who fail epilepsy surgery is problematic. Selected patients may be candidates for further surgery, potentially leading to a significant decrease in the frequency and severity of seizures. We present our long-term outcome series of highly investigated patients who failed resective epilepsy surgery and subsequently underwent reoperative resective procedures. METHODS We performed a retrospective consecutive analysis of patients who underwent reoperative procedures because of medically intractable epilepsy at our institution from 1990 to 2001. Seventy patients underwent reoperative epilepsy surgery, with 57 patients having a minimum follow-up period of 2 years. We assessed the relationship between seizure outcome and categorical variables using χ2 and Fisher's exact tests, and the relationship between outcome and continuous variables using a Wilcoxon rank-sum test. Statistical significance was set at a P value of 0.05. RESULTS Of the 57 patients (29 male and 28 female patients), the age of seizure onset ranged from 3 months to 39 years (mean, 10.7 ± 10.3 yr; median, 7 yr). The mean age at reoperation was 24.7 ± 12 years (range, 4–50 yr). The interval between first and second resection was 7 days to 16 years. The follow-up period ranged from 24 to 228 months (mean, 128 mo; mode, 132 mo). Seizure outcome was classified according to Engel's classification. Fifty-two percent of the patients had a favorable outcome (38.6% were Class I and 14.0% were Class II). Patients with tumors as their initial pathology had better outcome compared with patients with focal cortical dysplasia and mesial temporal sclerosis (P < 0.05). CONCLUSION Reoperation should be considered in selected patients failing epilepsy resective surgery because approximately 50% of patients may have benefit. Patients with cortical dysplasia and mesial temporal sclerosis are less likely to improve after reoperation.

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Focal cortical dysplasia: long term seizure outcome after surgical treatment

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.2006.105361 ◽

2007 ◽

Vol 78 (8) ◽

pp. 853-856 ◽

Cited By ~ 56

Author(s):

T Kral ◽

M von Lehe ◽

M Podlogar ◽

H Clusmann ◽

P Sussmann ◽

...

Keyword(s):

Surgical Treatment ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Seizure Outcome

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Long-term outcomes of epilepsy surgery in 85 pediatric patients followed up for over 10 years: a retrospective survey

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.12.peds16197 ◽

2017 ◽

Vol 19 (5) ◽

pp. 606-615 ◽

Cited By ~ 18

Author(s):

Hiroshi Hosoyama ◽

Kazumi Matsuda ◽

Tadahiro Mihara ◽

Naotaka Usui ◽

Koichi Baba ◽

...

Keyword(s):

Treatment Outcome ◽

Antiepileptic Drugs ◽

Epilepsy Surgery ◽

Social Engagement ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Seizure Outcome ◽

Neoplastic Lesions ◽

The Mean

OBJECTIVEThe aim of this study was to investigate the treatment outcomes and social engagement of patients who had undergone pediatric epilepsy surgery more than 10 years earlier.METHODSBetween 1983 and 2005, 110 patients younger than 16 years underwent epilepsy surgery at the National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders. The authors sent a questionnaire to 103 patients who had undergone follow-up for more than 10 years after surgery; 85 patients (82.5%) responded. The survey contained 4 categories: seizure outcome, use of antiepileptic drugs, social participation, and general satisfaction with the surgical treatment (resection of the epileptic focus, including 4 hemispherectomies). The mean patient age at the time of surgery was 9.8 ± 4.2 (SD) years, and the mean duration of postoperative follow-up was 15.4 ± 5.0 years. Of the 85 patients, 79 (92.9%) presented with a lesional pathology, such as medial temporal sclerosis, developmental/neoplastic lesions, focal cortical dysplasia, and gliosis in a single lobe.RESULTSFor 65 of the 85 responders (76.5%), the outcome was recorded as Engel Class I (including 15 [93.8%] of 16 patients with medial temporal sclerosis, 20 [80.0%] of 25 with developmental/neoplastic lesions, and 27 [73.0%] of 37 with focal cortical dysplasia). Of these, 29 (44.6%) were not taking antiepileptic drugs at the time of our survey, 29 (44.6%) held full-time jobs, and 33 of 59 patients (55.9%) eligible to drive had a driver's license. Among 73 patients who reported their degree of satisfaction, 58 (79.5%) were very satisfied with the treatment outcome.CONCLUSIONSThe seizure outcome in patients who underwent resective surgery in childhood and underwent followup for more than 10 years was good. Of 85 respondents, 65 (76.5%) were classified in Engel Class I. The degree of social engagement was relatively high, and the satisfaction level with the treatment outcome was also high. From the perspective of seizure control and social adaptation, resective surgery yielded longitudinal benefits in children with intractable epilepsy, especially those with a lesional pathology in a single lobe.

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Commentary on long-term seizure outcome in 211 patients with focal cortical dysplasia

Epilepsia ◽

10.1111/epi.13005 ◽

2015 ◽

Vol 56 (7) ◽

pp. 1176-1177 ◽

Cited By ~ 1

Author(s):

Marco Giulioni ◽

Matteo Martinoni ◽

Gianluca Marucci

Keyword(s):

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Seizure Outcome

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Long-term seizure outcome in 211 patients with focal cortical dysplasia

Epilepsia ◽

10.1111/epi.12876 ◽

2014 ◽

Vol 56 (1) ◽

pp. 66-76 ◽

Cited By ~ 86

Author(s):

Susanne Fauser ◽

Charles Essang ◽

Dirk-Matthias Altenmüller ◽

Anke Maren Staack ◽

Bernhard J. Steinhoff ◽

...

Keyword(s):

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Seizure Outcome

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Electroclinical and Multimodality Neuroimaging Characteristics and Predictors of Post-Surgical Outcome in Focal Cortical Dysplasia Type IIIa

Frontiers in Bioengineering and Biotechnology ◽

10.3389/fbioe.2021.810897 ◽

2022 ◽

Vol 9 ◽

Author(s):

Lingling Zhang ◽

Hailing Zhou ◽

Wei Zhang ◽

Xueying Ling ◽

Chunyuan Zeng ◽

...

Keyword(s):

Epilepsy Surgery ◽

Focal Cortical Dysplasia ◽

Univariate Analysis ◽

Postoperative Outcome ◽

Cortical Dysplasia ◽

Seizure Outcome ◽

Seizure Freedom ◽

Incomplete Resection ◽

Type Iiia ◽

Imaging Characteristics

Focal cortical dysplasia (FCD) type IIIa is an easily ignored cause of intractable temporal lobe epilepsy. This study aimed to analyze the clinical, electrophysiological, and imaging characteristics in FCD type IIIa and to search for predictors associated with postoperative outcome in order to identify potential candidates for epilepsy surgery. We performed a retrospective review including sixty-six patients with FCD type IIIa who underwent resection for drug-resistant epilepsy. We evaluated the clinical, electrophysiological, and neuroimaging features for potential association with seizure outcome. Univariate and multivariate analyses were conducted to explore their predictive role on the seizure outcome. We demonstrated that thirty-nine (59.1%) patients had seizure freedom outcomes (Engel class Ia) with a median postsurgical follow-up lasting 29.5 months. By univariate analysis, duration of epilepsy (less than 12 years) (p = 0.044), absence of contralateral insular lobe hypometabolism on PET/MRI (pLog-rank = 0.025), and complete resection of epileptogenic area (pLog-rank = 0.004) were associated with seizure outcome. The incomplete resection of the epileptogenic area (hazard ratio = 2.977, 95% CI 1.218–7.277, p = 0.017) was the only independent predictor for seizure recurrence after surgery by multivariate analysis. The results of past history, semiology, electrophysiological, and MRI were not associated with seizure outcomes. Carefully included patients with FCD type IIIa through a comprehensive evaluation of their clinical, electrophysiological, and neuroimaging characteristics can be good candidates for resection. Several preoperative factors appear to be predictive of the postoperative outcome and may help in optimizing the selection of ideal candidates to benefit from epilepsy surgery.

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In response: Long-term seizure outcome in 211 patients with focal cortical dysplasia

Epilepsia ◽

10.1111/epi.13017 ◽

2015 ◽

Vol 56 (7) ◽

pp. 1177-1178 ◽

Cited By ~ 4

Author(s):

Susanne Fauser ◽

Andreas Schulze-Bonhage

Keyword(s):

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Seizure Outcome

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