| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Department of Pediatric Neurology (P.K.), Charles University, Second Medical School, Motol University Hospital, Prague, Czech Republic; Department of Neurology (B.M., P.J., P.D., C.D., T.R., M.D.), Behavioral Medicine (B.K., G.R.), and Comprehensive Epilepsy Program (B.M., P.J., P.D., C.D., T.R., M.D.), Neuropsychology Section (B.K., G.R.), Department of Radiology (E.P.-J.), and Department of Neurological Surgery (G.M., J.R.), Brain Institute, Miami Children's Hospital, FL; Pathology and Laboratory Medicine (Neuropathology) and Neurology (H.V.V.), Los Angeles, CA; and Department of Neurology (T.R., M.D.), University of Miami Miller School of Medicine, FL.
Address correspondence and reprint requests to Dr. Pavel Krsek, Department of Pediatric Neurology, Charles University, Second Medical School, Motol University Hospital, V Uvalu 84, CZ 15006 Prague 5, Czech Republic pavel.krsek{at}post.cz.
Background: Focal cortical dysplasia (FCD) is recognized as the major cause of focal intractable epilepsy in childhood. Various factors influencing postsurgical seizure outcome in pediatric patients with FCD have been reported.
Objective: To analyze different variables in relation to seizure outcome in order to identify prognostic factors for selection of pediatric patients with FCD for epilepsy surgery.
Methods: A cohort of 149 patients with histologically confirmed mild malformations of cortical development or FCD with at least 2 years of postoperative follow-up was retrospectively studied; 113 subjects had at least 5 years of postoperative follow-up. Twenty-eight clinical, EEG, MRI, neuropsychological, surgical, and histopathologic parameters were evaluated.
Results: The only significant predictor of surgical success was completeness of surgical resection, defined as complete removal of the structural MRI lesion (if present) and the cortical region exhibiting prominent ictal and interictal abnormalities on intracranial EEG. Unfavorable surgical outcomes are mostly caused by overlap of dysplastic and eloquent cortical regions. There were nonsignificant trends toward better outcomes in patients with normal intelligence, after hemispherectomy and with FCD type II. Other factors such as age at seizure onset, duration of epilepsy, seizure frequency, associated pathologies including hippocampal sclerosis, extent of EEG and MRI abnormalities, as well as extent and localization of resections did not influence outcome. Twenty-five percent of patients changed Engel's class of seizure outcome after the second postoperative year.
Conclusions: The ability to define and fully excise the entire region of dysplastic cortex is the most powerful variable influencing outcome in pediatric patients with focal cortical dysplasia.
Abbreviations: FCD = focal cortical dysplasia; HS = hippocampal sclerosis; mMCD = mild malformations of cortical development; MST = multiple subpial transections; SGTCS = secondarily generalized tonic-clonic seizures; SS = standard scores.
See also page 211.
e-Pub ahead of print on November 12, 2008, at www.neurology.org.
Supported by grant IGA NR/8843-4 and VZ MZO 00064203.
Disclosure: The authors report no disclosures.
Received November 3, 2007. Accepted in final form August 5, 2008.
Related Articles
Neurology 2009 72: 211-216.
Neurology 2009 72: 206-207.
This article has been cited by other articles:
|
|
 |
|
  S. Aubert, F. Wendling, J. Regis, A. McGonigal, D. Figarella-Branger, J.-C. Peragut, N. Girard, P. Chauvel, and F. Bartolomei Local and remote epileptogenicity in focal cortical dysplasias and neurodevelopmental tumours Brain, November 1, 2009; 132(11): 3072 - 3086. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. W. Mathern Epilepsy surgery patients with cortical dysplasia: Present and future therapeutic challenges Neurology, January 20, 2009; 72(3): 206 - 207. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
