Surgical outcome and predictive factors in adult patients with intractable epilepsy and focal cortical dysplasia

Object Focal cortical dysplasia (FCD) is an important cause of intractable epilepsy and is at times treatable by resection. The now widespread use of MR imaging and recent advancement of functional imaging have increased the number of patients undergoing surgical treatment for FCD. The objective of this review is to critically examine and to provide a summary of surgical series on FCD published since 2000. Methods Studies concerning surgery for FCD were identified from MEDLINE and references of selected articles and book chapters. Data from these included studies were summarized and analyzed to identify factors correlated with seizure outcome. Results Sixteen studies were identified, and 469 patients met our selection criteria. Seizure-free outcome at 1-year postoperatively was achieved in 59.7% of the patients. Children and adults were equally likely to benefit from the surgery. Complete resection (OR 13.7, 95% CI 6.68–28.1; p < 0.0001) and temporal location (OR 2.15, 95% CI 1.26–3.69; p = 0.0073) were two positive prognostic indicators of seizure-free outcome. Utilization of invasive monitoring did not affect the chance of seizure remission, but firm conclusions could not be drawn because patients were not randomized. Conclusions The advancement of modern imaging has transformed the process of surgical candidate selection for partial epilepsy due to FCD. Patients from recent surgical series were more homogeneous in their clinical presentations and might represent FCD as an independent pathological entity. This likely explained the improved surgical outcome for this group of patients. These reports also documented the increased utilization of functional imaging, but their efficacy needs to be verified with further studies.

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Surgical outcome and predictive factors of epilepsy surgery in pediatric isolated focal cortical dysplasia

Epilepsy Research ◽

10.1016/j.eplepsyres.2017.11.012 ◽

2018 ◽

Vol 139 ◽

pp. 54-59 ◽

Cited By ~ 23

Author(s):

Sun Ah Choi ◽

Soo Yeon Kim ◽

Hyuna Kim ◽

Woo Joong Kim ◽

Hunmin Kim ◽

...

Keyword(s):

Epilepsy Surgery ◽

Predictive Factors ◽

Surgical Outcome ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia

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Clinical Application of Experimental Cortical Dysplasia in Rats

Journal of Child Neurology ◽

10.1177/08830738040190031401 ◽

2004 ◽

Vol 19 (3) ◽

pp. 351-356

Author(s):

Tatsuya Tanaka ◽

Hiroshige Tsuda ◽

Kiyotaka Hashizume ◽

Juro Sakurai ◽

Akira Hodozuka ◽

...

Keyword(s):

Surgical Outcome ◽

Focal Cortical Dysplasia ◽

Experimental Studies ◽

Intractable Epilepsy ◽

Cortical Dysplasia ◽

Surgical Results ◽

Postoperative Results ◽

Epileptiform Discharges ◽

Pathologic Classification

This report details clinical and experimental studies of focal cortical dysplasia. The first part deals with 14 surgical cases of children with intractable epilepsy. At surgery, intraoperative electrocorticography was performed to localize the epileptic foci under neuroleptanalgesia. Thirteen patients showed epileptiform discharges on this preresection electrocorticography. All foci in noneloquent areas were resected. Patients who had undergone total lesionectomy with complete focus resection showed the most favorable postoperative results. However, the positive correlation between the intraoperative electrocorticographic findings and the pathologic classification of cortical dysplasia was not found in the present study. Nine patients have been seizure free with reduced medication and two patients have achieved worthwhile improvement. We conclude that intraoperative electrocorticography can improve the surgical outcome for intractable epilepsy by localizing epileptic foci for resection. The second part describes a kainic acid—induced experimental model of focal cortical dysplasia, which demonstrated not only the epileptic properties of the dysplasia but also the perilesional epileptogenicity. The findings supported the surgical results for the patients with focal cortical dysplasia. ( J Child Neurol 2005;20:351—356).

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Intravenous Immunoglobulin as a Treatment for Intractable Epilepsy Secondary to Focal Cortical Dysplasia: A Meta-analysis

Pediatric Neurology ◽

10.1016/j.pediatrneurol.2017.07.009 ◽

2017 ◽

Vol 76 ◽

pp. 79-81 ◽

Cited By ~ 2

Author(s):

Fatema Al Amrani ◽

Roy Dudley ◽

Luis E. Bello-Espinosa ◽

Bernard Rosenblatt ◽

Myriam Srour ◽

...

Keyword(s):

Intravenous Immunoglobulin ◽

Focal Cortical Dysplasia ◽

Meta Analysis ◽

Intractable Epilepsy ◽

Cortical Dysplasia

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Surgical Treatment of Intractable Epilepsy Associated with Focal Cortical Dysplasia

Novel Treatment of Epilepsy ◽

10.5772/19287 ◽

2011 ◽

Cited By ~ 1

Author(s):

Zhao Jizong ◽

Fei Zhou ◽

Bai Hongmi

Keyword(s):

Surgical Treatment ◽

Focal Cortical Dysplasia ◽

Intractable Epilepsy ◽

Cortical Dysplasia

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Type II focal cortical dysplasia: Electroclinical phenotype and surgical outcome related to imaging

Epilepsia ◽

10.1111/j.1528-1167.2011.03363.x ◽

2012 ◽

Vol 53 (2) ◽

pp. 349-358 ◽

Cited By ~ 97

Author(s):

Francine Chassoux ◽

Elisabeth Landré ◽

Charles Mellerio ◽

Baris Turak ◽

Michael W. Mann ◽

...

Keyword(s):

Surgical Outcome ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Type Ii

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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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