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

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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Predictors of postoperative long-term seizure outcome in pediatric patients with focal cortical dysplasia type II at a German tertiary epilepsy center

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.7.peds21219 ◽

2021 ◽

pp. 1-9

Author(s):

Abdallah Salemdawod ◽

Johannes Wach ◽

Mohammed Banat ◽

Valeri Borger ◽

Motaz Hamed ◽

...

Keyword(s):

Epilepsy Surgery ◽

Pediatric Patients ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Complete Resection ◽

Seizure Outcome ◽

Seizure Freedom ◽

Type Ii ◽

Younger Age

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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The influence of lesion volume, perilesion resection volume, and completeness of resection on seizure outcome after resective epilepsy surgery for cortical dysplasia in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.10.peds14282 ◽

2015 ◽

Vol 15 (6) ◽

pp. 644-650 ◽

Cited By ~ 30

Author(s):

Chima O. Oluigbo ◽

Jichuan Wang ◽

Matthew T. Whitehead ◽

Suresh Magge ◽

John S. Myseros ◽

...

Keyword(s):

Epilepsy Surgery ◽

Seizure Control ◽

Brain Mri ◽

Age At Onset ◽

Cortical Dysplasia ◽

Complete Resection ◽

Seizure Outcome ◽

Seizure Freedom ◽

Lesion Volume ◽

Resection Volume

OBJECT Focal cortical dysplasia (FCD) is one of the most common causes of intractable epilepsy leading to surgery in children. The predictors of seizure freedom after surgical management for FCD are still unclear. The objective of this study was to perform a volumetric analysis of factors shown on the preresection and postresection brain MRI scans of patients who had undergone resective epilepsy surgery for cortical dysplasia and to determine the influence of these factors on seizure outcome. METHODS The authors reviewed the medical records and brain images of 43 consecutive patients with focal MRI-documented abnormalities and a pathological diagnosis of FCD who had undergone surgical treatment for refractory epilepsy. Preoperative lesion volume and postoperative resection volume were calculated by manual segmentation using OsiriX PRO software. RESULTS Forty-three patients underwent first-time surgery for resection of an FCD. The age range of these patients at the time of surgery ranged from 2 months to 21.8 years (mean age 7.3 years). The median duration of follow-up was 20 months. The mean age at onset was 31.6 months (range 1 day to 168 months). Complete resection of the area of an FCD, as adjudged from the postoperative brain MR images, was significantly associated with seizure control (p = 0.0005). The odds of having good seizure control among those who underwent complete resection were about 6 times higher than those among the patients who did not undergo complete resection. Seizure control was not significantly associated with lesion volume (p = 0.46) or perilesion resection volume (p = 0.86). CONCLUSIONS The completeness of FCD resection in children is a significant predictor of seizure freedom. Neither lesion volume nor the further resection of perilesional tissue is predictive of seizure freedom.

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The Impact of Intraoperative Electrocorticography on Seizure Outcome After Resection of Pediatric Brain Tumors: A Cohort Study

Neurosurgery ◽

10.1093/neuros/nyy342 ◽

2018 ◽

Vol 85 (3) ◽

pp. 375-383 ◽

Cited By ~ 1

Author(s):

Faith C Robertson ◽

Nicole J Ullrich ◽

Peter E Manley ◽

Hasan Al-Sayegh ◽

Clement Ma ◽

...

Keyword(s):

Pediatric Patients ◽

Focal Cortical Dysplasia ◽

Tumor Resection ◽

Cortical Dysplasia ◽

Class I ◽

Gross Total Resection ◽

Seizure Outcome ◽

Seizure Freedom ◽

Total Resection ◽

The Impact

AbstractBACKGROUNDIntraoperative electrocorticography (ECoG) has been utilized in patients with tumor-associated seizures; however, its effectiveness for seizure control remains controversial.OBJECTIVETo evaluate clinical outcomes in pediatric patients undergoing lesionectomy with or without ECoG.METHODSPatients undergoing brain tumor resection at Boston Children's Hospital were examined retrospectively (2005-2014). Inclusion criteria involved diagnosis of a supratentorial tumor, ≥2 unequivocal seizures, and ≥6 mo follow-up. Patients with isolated cortical dysplasia or posterior fossa tumors were excluded. Logistic regression models evaluated predictors of ECoG use, and the impact of ECoG, gross total resection, and focal cortical dysplasia with tumors on seizure freedom by Engel Class and anti-epileptic drug use (AED).RESULTSA total of 119 pediatric patients were included (n = 69 males, 58%; median age, 11.3 yr). Forty-one patients (34.5%) had ECoG-guided surgery. Preoperative seizure duration and number and duration of AED use were significant predictors for undergoing ECoG. There were no differences in seizure freedom (Engel Class I) or improved Engel Score (Class I-II vs III-IV) in patients who did or did not have ECoG at 30 d, 6 mo, and 1, 2, or 5 yr. Patients undergoing ECoG required a greater number of AEDs at 6 mo (P = .01), although this difference disappeared at subsequent time intervals. Gross total resection predicted seizure freedom at 30 d and 6 mo postsurgery (P = .045).CONCLUSIONThis retrospective study, one of the largest evaluating the use of ECoG during tumor resection, suggests that ECoG does not provide improved seizure freedom compared to lesionectomy alone for children.

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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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Resective surgery for medically refractory epilepsy using intraoperative MRI and functional neuronavigation: the Erlangen experience of 415 patients

Neurosurgical FOCUS ◽

10.3171/2015.12.focus15554 ◽

2016 ◽

Vol 40 (3) ◽

pp. E15 ◽

Cited By ~ 19

Author(s):

Karl Roessler ◽

Andrea Hofmann ◽

Bjoern Sommer ◽

Peter Grummich ◽

Roland Coras ◽

...

Keyword(s):

Surgical Procedures ◽

Focal Cortical Dysplasia ◽

Hippocampal Sclerosis ◽

Cortical Dysplasia ◽

Intraoperative Mri ◽

Class I ◽

Seizure Outcome ◽

Incomplete Resection ◽

Diffuse Glioma ◽

Resection Volume

OBJECTIVE Intraoperative overestimation of resection volume in epilepsy surgery is a well-known problem that can lead to an unfavorable seizure outcome. Intraoperative MRI (iMRI) combined with neuronavigation may help surgeons avoid this pitfall and facilitate visualization and targeting of sometimes ill-defined heterogeneous lesions or epileptogenic zones and may increase the number of complete resections and improve seizure outcome. METHODS To investigate this hypothesis, the authors conducted a retrospective clinical study of consecutive surgical procedures performed during a 10-year period for epilepsy in which they used neuronavigation combined with iMRI and functional imaging (functional MRI for speech and motor areas; diffusion tensor imaging for pyramidal, speech, and visual tracts; and magnetoencephalography and electrocorticography for spike detection). Altogether, there were 415 patients (192 female and 223 male, mean age 37.2 years; 41% left-sided lesions and 84.9% temporal epileptogenic zones). The mean preoperative duration of epilepsy was 17.5 years. The most common epilepsy-associated pathologies included hippocampal sclerosis (n = 146 [35.2%]), long-term epilepsy-associated tumor (LEAT) (n = 67 [16.1%]), cavernoma (n = 45 [10.8%]), focal cortical dysplasia (n = 31 [7.5%]), and epilepsy caused by scar tissue (n = 23 [5.5%]). RESULTS In 11.8% (n = 49) of the surgeries, an intraoperative second-look surgery (SLS) after incomplete resection verified by iMRI had to be performed. Of those incomplete resections, LEATs were involved most often (40.8% of intraoperative SLSs, 29.9% of patients with LEAT). In addition, 37.5% (6 of 16) of patients in the diffuse glioma group and 12.9% of the patients with focal cortical dysplasia underwent an SLS. Moreover, iMRI provided additional advantages during implantation of grid, strip, and depth electrodes and enabled intraoperative correction of electrode position in 13.0% (3 of 23) of the cases. Altogether, an excellent seizure outcome (Engel Class I) was found in 72.7% of the patients during a mean follow-up of 36 months (range 3 months to 10.8 years). The greatest likelihood of an Engel Class I outcome was found in patients with cavernoma (83.7%), hippocampal sclerosis (78.8%), and LEAT (75.8%). Operative revisions that resulted from infection occurred in 0.3% of the patients, from hematomas in 1.6%, and from hydrocephalus in 0.8%. Severe visual field defects were found in 5.2% of the patients, aphasia in 5.7%, and hemiparesis in 2.7%, and the total mortality rate was 0%. CONCLUSIONS Neuronavigation combined with iMRI was beneficial during surgical procedures for epilepsy and led to favorable seizure outcome with few specific complications. A significantly higher resection volume associated with a higher chance of favorable seizure outcome was found, especially in lesional epilepsy involving LEAT or diffuse glioma.

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Focal Cortical Dysplasia Type Ⅲ Related Medically Refractory Epilepsy: MRI Findings and Potential Predictors of Surgery Outcome

Diagnostics ◽

10.3390/diagnostics11122225 ◽

2021 ◽

Vol 11 (12) ◽

pp. 2225

Author(s):

Xiaozhuan Wang ◽

Dabiao Deng ◽

Chengqian Zhou ◽

Honglin Li ◽

Xueqin Guan ◽

...

Keyword(s):

Refractory Epilepsy ◽

Focal Cortical Dysplasia ◽

Febrile Seizures ◽

Cortical Dysplasia ◽

Seizure Outcome ◽

Incomplete Resection ◽

Negative Finding ◽

Number Of Patients ◽

Medically Refractory Epilepsy

This study aims to explore the relationship between neuropathologic and the post-surgical prognosis of focal cortical dysplasia (FCD) typed-Ⅲ-related medically refractory epilepsy. A total of 266 patients with FCD typed-Ⅲ-related medically refractory epilepsy were retrospectively studied. Presurgical clinical data, type of surgery, and postsurgical seizure outcome were analyzed. The minimum post-surgical follow-up was 1 year. A total of 266 patients of FCD type Ⅲ were included in this study and the median follow-up time was 30 months (range, 12~48 months). Age at onset ranged from 1.0 years to 58.0 years, with a median age of 12.5 years. The number of patients under 12 years old was 133 (50%) in patients with FCD type Ⅲ. A history of febrile seizures was present in 42 (15.8%) cases. In the entire postoperative period, 179 (67.3%) patients were seizure-free. Factors with p < 0.15 in univariate analysis, such as age of onset of epilepsy (p = 0.145), duration of epilepsy (p = 0.004), febrile seizures (p = 0.150), being MRI-negative (p = 0.056), seizure type (p = 0.145) and incomplete resection, were included in multivariate analysis. Multivariate analyses revealed that MRI-negative findings of FCD (OR 0.34, 95% CI 0.45–0.81, p = 0.015) and incomplete resection (OR 0.12, 95% CI 0.05–0.29, p < 0.001) are independent predictors of unfavorable seizure outcomes. MRI-negative finding of FCD lesions and incomplete resection were the most important predictive factors for poor seizure outcome in patients with FCD type Ⅲ.

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Impact of focal cortical dysplasia Type IIIa on seizure outcome following anterior mesial temporal lobe resection for the treatment of epilepsy

Journal of Neurosurgery ◽

10.3171/2017.2.jns161295 ◽

2018 ◽

Vol 128 (6) ◽

pp. 1668-1673 ◽

Cited By ~ 6

Author(s):

Lasse Dührsen ◽

Thomas Sauvigny ◽

Patrick M. House ◽

Stefan Stodieck ◽

Brigitte Holst ◽

...

Keyword(s):

Temporal Lobe ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Seizure Outcome ◽

Histopathological Analysis ◽

Type Iiia ◽

Temporal Pole ◽

Temporal Lobe Resection ◽

Mesial Temporal Lobe ◽

The Impact

OBJECTIVETemporal lobe epilepsy (TLE) is the most common type of pharmacoresistant focal epilepsy, for which anterior mesial temporal lobe resection (AMTLR) is a treatment option. Focal cortical dysplasia Type IIIa (FCD IIIa), a developmental lesion resulting from defects in neuronal formation and migration into the temporal pole (FCD I) combined with hippocampal sclerosis (HS), can be a neuropathological finding. In this study, the authors investigate the impact of FCD IIIa on seizure outcome in patients with TLE who underwent AMTLR.METHODSThe authors performed a retrospective analysis of all patients with TLE who underwent AMTLR at their institution between June 2011 and April 2014. Histopathological analysis was used to determine whether patients had HS together with FCD I (FCD IIIa) or HS alone. The groups were compared with regard to age, sex, years of epilepsy, and seizure outcome using the Engel classification.RESULTSA total of 51 patients with TLE underwent AMTLR at the authors’ institution. FCD IIIa was diagnosed in 13 cases. The patients experienced seizures for a mean duration of 31.1 years. The mean length of follow-up after the procedure was 18 months. All patients with FCD IIIa had a favorable seizure outcome (Engel Class I or II) compared with 71% of the patients with no pathological findings in the temporal pole (p < 0.01).CONCLUSIONSPatients with histopathologically proven FCD IIIa had a significantly better seizure outcome after AMTLR than patients with HS alone. Further effort should be made during presurgical evaluation to detect FCD IIIa so that the most suitable resection technique can be chosen and postoperative seizure outcome can be predicted for patient counseling.

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Long‐term seizure outcome after epilepsy surgery in patients with mild malformation of cortical development and focal cortical dysplasia

Epilepsia Open ◽

10.1002/epi4.12289 ◽

2018 ◽

Vol 4 (1) ◽

pp. 170-175 ◽

Cited By ~ 4

Author(s):

Tim J. Veersema ◽

Banu Swampillai ◽

Cyrille H. Ferrier ◽

Pieter Eijsden ◽

Peter H. Gosselaar ◽

...

Keyword(s):

Epilepsy Surgery ◽

Focal Cortical Dysplasia ◽

Cortical Development ◽

Cortical Dysplasia ◽

Seizure Outcome ◽

Malformation Of Cortical Development

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Factors predicting 10-year seizure freedom after temporal lobe resection

Zeitschrift für Epileptologie ◽

10.1007/s10309-019-00302-x ◽

2020 ◽

Vol 33 (1) ◽

pp. 50-61 ◽

Cited By ~ 2

Author(s):

Friedhelm C. Schmitt ◽

H.‑Joachim Meencke

Keyword(s):

Temporal Lobe ◽

Epilepsy Surgery ◽

Univariate Analysis ◽

Class I ◽

Seizure Outcome ◽

Seizure Freedom ◽

Patient Counseling ◽

Long Term Follow Up

Abstract Background Resective surgery is an established and evidence-based treatment approach in pharmacoresistant temporal lobe epilepsy (TLE). Extra-long-term follow-up data are important to allow for good patient counseling. So far, only few trials provide prospective or retrospective data exceeding 5 years. Objective This study aimed to present data of continuous seizure outcome over an extended time period, with a particular focus on patients who remained seizure free for 10 years. Methods We analyzed seizure outcome after epilepsy surgery for TLE in 46 consecutive patients, who were seen on an annual basis for 10 years in a single center (Epilepsy Center Berlin Brandenburg). Factors for remaining seizure free for 10 years were determined by univariate analysis. Results The class I outcome changed each year by 74–78%. Of the patients, 63% remained continuously in Engel class I (48% Engel Class IA for 10 years) for 10 years. Six patients were never seizure free (12.5%). After 10 years, 35% of the patients were cured (i.e., seizure-free without medication). A higher number of antiepileptic drugs and seizures before surgery as well as the indication for invasive presurgical monitoring were associated with “unsuccessful surgery.” Conclusion With almost half of the patients completely seizure free and more than a third “cured,” epilepsy surgery remains the mainstay of therapy for TLE patients. Analysis in larger cohorts with extra-long-term follow-up is needed to assess good prognostic factors and other postsurgical outcome issues such as neuropsychological, psychiatric, and psychosocial outcomes.

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