Surgical outcomes of focal cortical dysplasia: a follow-up study of 102 patients_Journal of Epilepsy

Authors：

 CHENGJin ¹ ,  CHENYangmei ¹ , SHENDinglie ² , LANWeiyin ²

1. Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China;
2. Epileptic Center, Guangdong Sanjiu Brain Hospital, Guangzhou 510510, China;

Corresponding?author：

CHENYangmei, Email: chenym1997@sina.com

Keywords：

Drug resistant epilepsy; Focal cortical dysplasia; Surgery; Prognosis

DOI：

10.7507/2096-0247.20160084

Video：

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Objective To explore the prognostic factors for seizure control in focal cortical dysplasia(FCD)by analyzing the clinical features of FCD patients. Methods We conducted a follow-up study of patients, who were confirmed FCD by pathology after resective surgery,in Epileptic Center, Guangdong Sanjiu Brain Hospital, From January 1, 2014 to December 31, 2014. All patients were followed at least 6 months,they were divided into seizure control group(Engel class I) and seizure group(Engel classⅡ-class Ⅳ) according to surgical outcomes. Clinical features,auxiliary examinations and pathological classification were compared between two groups. Results 102 patients were included, male 65 cases (63.7%), female 37 cases (36.3%), onset age 0.01~45 years old, average (10.3±8.26) years old, surgery age (3~47) years old, average (21.21±8.9) years old, all had seizure onset. 83 (81.4%) patients in seizure control group, 19 (18.6%) patients in seizure group. There are 14.5% of the patients' onset ages are younger than 3 years old, 59.8% preoperative electroencephalogram recording a diffusion epileptiform discharge, 32.5% orientation of magnetic resonance imaging (MRI) and electroencephalography (EEG) is inconsistent, 49.4% postoperative electroencephalogram (EEG) reveal an epileptiform discharge, 45.2% of the patients had intellectual disability, 36.1% had an absence of a lesion on MRI, in seizure control group. However,in seizure group they respectively 36.8%, 72.2%, 89.5%, 68.4%,94.1%, 89.5%. Patients in seizure control group got an average scores of (89.4±18.53) in performance intelligence quotient (PIQ)test, while, seizure group 65.80±15.71.There has a statistical significance between two groups. Conclusion Postoperative seizure outcome was favorable in patients with FCD, onset ages younger 3 years old, intellectual disability,getting a lower scores in PIQ test, preoperative electroencephalogram recording a diffusion epileptic discharge, inconsistent orientation of MRI and EEG, and postoperative EEG reveal an epileptiform discharge may be predictive for the postoperative outcome.

Citation： CHENGJin, CHENYangmei, SHENDinglie, LANWeiyin. Surgical outcomes of focal cortical dysplasia: a follow-up study of 102 patients. Journal of Epilepsy, 2016, 2(6): 479-483. doi: 10.7507/2096-0247.20160084 Copy

1.	Taylor DC, Falconer MA, Bruton CJ, et al. Focal dysplasia of the cerebral cortex in epilepsy. J Neurol Neurosurg Psychiatry, 1971, 34(4):369-387.
2.	Blümcke I, Thom M, Aronica E, et al. The clinicopathologic spectrum of focal cortical dysplasias:a consensus classification proposed by an ad hoc task force of the ILAE Diagnostic methods commission. Epilepsia, 2011, 52(1):158-174.
3.	Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia, 1981, 22(4):489-501.
4.	Kakita A. Surgical pathologic features of cerebr cortical lesions taken from 600 patients with intractable epilepsy. Brain Dev, 2013, 35(8):793-801.
5.	Rowland NC, Englot DJ, Cage TA, et al. A meta-analysis of predictors of seizure freedom in the surgical management of focal cortical dysplasia. J Neurosurg, 2012, 116(5):1035-1041.
6.	林元相, 林堃, 康德智, 等. 局灶性皮質發育不良相關性難治性癲癇的手術預后及其相關影響因素分析. 中華醫學雜志, 2012, 92(25):1763-1766.
7.	Kwon HE, Eom S, Kang HC, et al.Surgical treatment of pediatric focal cortical dysplasia:clinical spectrum and surgical outcome. Neurology, 2016, 87(9):945-951.
8.	Chassoux F, Landré E, Mellerio C, et al. Type Ⅱ focal cortical dysplasia:electroclinical phenotype and surgical outcome related to imaging. Epilepsia, 2012, 53(2):349-358.
9.	Cossu M, Lo Russo G, Francione S, et al.Epilepsy surgery in children:results and predictors of outcome on seizures. Epilepsia, 2008, 49(1):65-72.
10.	Noli D, Bartuluchi M, González FS, et al. Type Ⅱ focal cortical dysplasia:electroclinical study and surgical outcome in 31 pediatric patients. Childs Nerv Syst, 2013, 29(11):2079-2087.
11.	Otsuki T, Honda R, Takahashi A, et al. Surgical management of cortical dysplasia in infancy and early childhood. Brain Dev, 2013, 35(8):802-809.
12.	Mühlebner A, Gr ppel G, Dressler A, et al. Epilepsy surgery in children and adolescents with malformations of cortical development-outcome and impact of the new ILAE classification on focal cortical dysplasia. Epilepsy Res, 2014, 108(9):1652-1661.
13.	Phi JH, Cho BK, Wang KC, et al. Longitudinal analyses of the surgical outcomes of pediatric epilepsy patients with focal cortical dysplasia. J Neurosurg Pediatr, 2010, 6(1):49-56.
14.	Chern JJ, Patel AJ, Jea A, et al.Surgical outcome for focal cortical dysplasia:an analysis of recent surgical series. J Neurosurg Pediatr, 2010, 6(5):452-458.
15.	Xue H, Cai L, Dong S, et al. Clinical characteristics and post-surgical outcomes of focal cortical dysplasia subtypes. J Clin Neurosci, 2016, 23(7):68-72.
16.	Mrelashvili A, Witte RJ, Wirrell EC, et al.Seizure freedom in children with pathology-confirmed focal cortical dysplasia. Pediatr Neurol, 2015, 53(6):513-518.
17.	Kim DW, Lee SK, Chu K, Park KI, et al. Predictors of surgical outcome and pathologic considerations in focal cortical dysplasia. Neurology, 2009, 72(3):211-216.
18.	Fauser S, Essang C, Altenmüller DM, et al. Long-term seizure outcome in 211 patients with focal cortical dysplasia. Epilepsia, 2015, 56(1):66-76.

1. Taylor DC, Falconer MA, Bruton CJ, et al. Focal dysplasia of the cerebral cortex in epilepsy. J Neurol Neurosurg Psychiatry, 1971, 34(4):369-387.
2. Blümcke I, Thom M, Aronica E, et al. The clinicopathologic spectrum of focal cortical dysplasias:a consensus classification proposed by an ad hoc task force of the ILAE Diagnostic methods commission. Epilepsia, 2011, 52(1):158-174.
3. Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia, 1981, 22(4):489-501.
4. Kakita A. Surgical pathologic features of cerebr cortical lesions taken from 600 patients with intractable epilepsy. Brain Dev, 2013, 35(8):793-801.
5. Rowland NC, Englot DJ, Cage TA, et al. A meta-analysis of predictors of seizure freedom in the surgical management of focal cortical dysplasia. J Neurosurg, 2012, 116(5):1035-1041.
6. 林元相, 林堃, 康德智, 等. 局灶性皮質發育不良相關性難治性癲癇的手術預后及其相關影響因素分析. 中華醫學雜志, 2012, 92(25):1763-1766.
7. Kwon HE, Eom S, Kang HC, et al.Surgical treatment of pediatric focal cortical dysplasia:clinical spectrum and surgical outcome. Neurology, 2016, 87(9):945-951.
8. Chassoux F, Landré E, Mellerio C, et al. Type Ⅱ focal cortical dysplasia:electroclinical phenotype and surgical outcome related to imaging. Epilepsia, 2012, 53(2):349-358.
9. Cossu M, Lo Russo G, Francione S, et al.Epilepsy surgery in children:results and predictors of outcome on seizures. Epilepsia, 2008, 49(1):65-72.
10. Noli D, Bartuluchi M, González FS, et al. Type Ⅱ focal cortical dysplasia:electroclinical study and surgical outcome in 31 pediatric patients. Childs Nerv Syst, 2013, 29(11):2079-2087.
11. Otsuki T, Honda R, Takahashi A, et al. Surgical management of cortical dysplasia in infancy and early childhood. Brain Dev, 2013, 35(8):802-809.
12. Mühlebner A, Gr ppel G, Dressler A, et al. Epilepsy surgery in children and adolescents with malformations of cortical development-outcome and impact of the new ILAE classification on focal cortical dysplasia. Epilepsy Res, 2014, 108(9):1652-1661.
13. Phi JH, Cho BK, Wang KC, et al. Longitudinal analyses of the surgical outcomes of pediatric epilepsy patients with focal cortical dysplasia. J Neurosurg Pediatr, 2010, 6(1):49-56.
14. Chern JJ, Patel AJ, Jea A, et al.Surgical outcome for focal cortical dysplasia:an analysis of recent surgical series. J Neurosurg Pediatr, 2010, 6(5):452-458.
15. Xue H, Cai L, Dong S, et al. Clinical characteristics and post-surgical outcomes of focal cortical dysplasia subtypes. J Clin Neurosci, 2016, 23(7):68-72.
16. Mrelashvili A, Witte RJ, Wirrell EC, et al.Seizure freedom in children with pathology-confirmed focal cortical dysplasia. Pediatr Neurol, 2015, 53(6):513-518.
17. Kim DW, Lee SK, Chu K, Park KI, et al. Predictors of surgical outcome and pathologic considerations in focal cortical dysplasia. Neurology, 2009, 72(3):211-216.
18. Fauser S, Essang C, Altenmüller DM, et al. Long-term seizure outcome in 211 patients with focal cortical dysplasia. Epilepsia, 2015, 56(1):66-76.

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