Focal cortical dysplasia type II: biological features and clinical perspectives
Sanjay M Sisodiya1, Susanne Fauser, J Helen Cross
1Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, UK. sisodiya@ion.ucl.ac.uk
Abstract:
Focal cortical dysplasia (FCD) type II is an important cause of drug-resistant epilepsy. Clinical presentation is variable, and depends on age of onset of seizures and the location and size of lesion. As FCD type II cannot be diagnosed with certainty in the clinic, in vivo identification by use of MRI is important. Diagnosis will have a major effect on management of this pathology as it should prompt referral for specialist assessment. Drug treatment commonly proves ineffective, whereas appropriate surgical treatment can be curative in many cases. The dramatic cellular anomalies of FCD seen at histopathology indicate a widespread pattern of molecular disruption underpinning the structural disorganisation of the cortex. The cause for FCD has not been firmly established, and there are no explanations for its potent intrinsic ability to cause seizures. There seem to be both neurodevelopmental abnormalities and possible premature neurodegeneration in FCD. Understanding the coordination of the abnormal processes in FCD type II might help to promote improved detection in vivo, direct treatment strategies, and perhaps help explain the development, differentiation, and loss of brain cells, with broad implications for the epilepsies and other neurological disorders.
Insights
Focal cortical dysplasia (FCD) type II causes drug-resistant epilepsy. Improved in vivo MRI detection can guide surgical treatment, offering a potential cure for this challenging neurological disorder.
Area of Science:
- Neurology
- Neuroscience
- Medical Imaging
Background:
- Focal cortical dysplasia (FCD) type II is a significant cause of drug-resistant epilepsy.
- Diagnosis is challenging due to variable clinical presentations and reliance on histopathology.
- In vivo identification via MRI is crucial for effective patient management.
Purpose of the Study:
- To highlight the importance of in vivo MRI for diagnosing FCD type II.
- To emphasize the impact of accurate diagnosis on treatment strategies.
- To explore the underlying cellular anomalies and their implications for epilepsy.
Main Methods:
- Review of clinical presentations and diagnostic challenges of FCD type II.
- Discussion of the role of MRI in identifying FCD type II lesions.
- Analysis of histopathological findings and their molecular underpinnings.
Main Results:
- FCD type II presents variably, often requiring specialist assessment.
- Surgical intervention can be curative when FCD type II is accurately diagnosed.
- Cellular anomalies suggest widespread molecular disruption and potential neurodegeneration.
Conclusions:
- Improved in vivo MRI detection of FCD type II is essential.
- Accurate diagnosis directs patients towards potentially curative surgical options.
- Understanding FCD type II mechanisms may offer broader insights into neurological disorders and epilepsy.
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