Type II focal cortical dysplasia: electroclinical study and surgical outcome in 31 pediatric patients
Daniel Noli1, Marcelo Bartuluchi, Federico Sanchez González
1Neurology Unit-Epilepsy Group, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, CP 1245, Buenos Aires, Argentina.
Insights
Surgery offers the best treatment for pediatric focal cortical dysplasia (FCD) type II, significantly improving refractory epilepsy. Early diagnosis and intervention, especially with onset after age two, correlate with better surgical outcomes.
Area of Science:
- Neurology
- Pediatric Epilepsy
- Neurosurgery
Background:
- Focal cortical dysplasia (FCD) type II is a significant cause of drug-resistant epilepsy in children.
- Understanding the electroclinical features and surgical outcomes is crucial for optimizing patient management.
Purpose of the Study:
- To analyze the electroclinical characteristics of pediatric patients with FCD type II.
- To evaluate the surgical outcomes and long-term prognosis in this patient cohort.
Main Methods:
- Retrospective descriptive study of 31 pediatric patients with histopathologically confirmed FCD type II.
- Inclusion criteria: abnormal MRI, minimum 1-year follow-up.
- Data collected on epilepsy features, neurological examination, EEG, and surgical outcomes (Engel classification).
Main Results:
- All 31 patients presented with severe focal epilepsy; some experienced infantile spasms or status epilepticus.
- Seizures frequently occurred during sleep and in clusters.
- Post-surgery, 67.7% achieved Engel class I outcome, indicating seizure freedom or significant improvement.
- A positive correlation was found between later age of epilepsy onset (>2 years) and favorable prognosis.
Conclusions:
- Surgical intervention is the most effective treatment for pediatric refractory focal epilepsy caused by FCD type II.
- Age at epilepsy onset is a significant prognostic factor, with later onset associated with better surgical results.
Objective:
The aim of this study was to analyze the electroclinical features and surgical outcome of 31 pediatric patients with focal cortical dysplasia (FCD) type II.
Material And Methods:
We conducted a retrospective, descriptive study of 31 patients with FCD type II followed between 1998 and 2011. We included patients with FCD type II confirmed by histopathological examination with abnormal magnetic resonance imaging and at least 1 year of follow-up.
Results:
All patients had severe focal epilepsy; in infancy, four of them had also had epileptic spasms, associated with hypsarrhythmia in three. Focal status epilepticus occurred in five patients (16 %) and epilepsia partialis continua in one (3.2 %). Seizures occurred during sleep in 20 (64.5 %) and in clusters in 19 (61.3 %) patients. Neurological examination showed a mild motor deficit in seven (22.8 %) patients. Interictal abnormalities were characterized by rhythmic spikes and polyspike discharges, increasing during sleep in 13 (41.9 %) patients. Average time of follow-up after surgery was 4.7 years with a median time of 4 years and a range from 1 to 9 years. Engel classification class I was found in 20 (67.7 %) and class II in 3 cases (9.6 %). There were no significant changes after an average time of follow-up of 4.7 years.
Conclusion:
Our results confirm that surgery is the best treatment option for pediatric patients with refractory focal epilepsy due to type II FCD. A statistically significant correlation was found between a good prognosis and age at epilepsy onset older than 2 years.
