[Malformation of cortical development: which strategy is best?]

Area of Science:

• Neuroscience
• Developmental Biology
• Neurology

Context:

• Malformations of cortical development (MCD) represent a spectrum of cerebral lesions from abnormal embryogenesis.
• MCD frequently co-occur with drug-resistant epilepsy and neurological/cognitive deficits.

Purpose:

• To review the diagnostic and therapeutic advancements in Malformations of Cortical Development.
• To highlight the role of neuroimaging and invasive monitoring in managing MCD.

Summary:

• Diagnosis of MCD has improved with advanced imaging, identifying more cases, including cryptogenic epilepsy.
• Classifications integrating clinical, imaging, genetic, and pathological data enable homogeneous patient series analysis and optimized therapies.
• Surgical treatment is effective for focal MCD (e.g., focal cortical dysplasia, dysembryoplastic neuroepithelial tumors, gangliogliomas) and some diffuse forms (e.g., tuberous sclerosis, periventricular heterotopia, polymicrogyria).
• Stereoelectroencephalography (SEEG) is crucial for mapping epileptogenic zones and planning resections in MCD, though non-invasive methods suffice for many focal types.

Impact:

• Improved diagnostic accuracy for MCD through advanced neuroimaging techniques.
• Enhanced surgical strategies for both focal and diffuse MCD, leading to favorable outcomes.
• Better understanding of epileptogenesis in MCD through integrated neurophysiological, imaging, and pathological data.