Seizure outcome of infantile spasms with focal cortical dysplasia
Joon Won Kang1, Seon Kyeong Rhie, Rita Yu
1Department of Pediatrics, Chungnam Naional University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea.
Insights
For infantile spasms (IS) with focal cortical dysplasia (FCD), ketogenic diet (KD) and surgery offer better seizure control than antiepileptic drugs (AEDs) for medically refractory cases.
Area of Science:
- Pediatric Neurology
- Epileptology
Background:
- Infantile spasms (IS) are a severe epilepsy syndrome.
- Focal cortical dysplasia (FCD) is a common cause of refractory epilepsy in infants.
- Early diagnosis and effective treatment are crucial for improving outcomes in IS with FCD.
Purpose of the Study:
- To evaluate the seizure outcomes of infantile spasms (IS) associated with focal cortical dysplasia (FCD).
- To compare the efficacy of different treatment modalities for IS with FCD.
Main Methods:
- Retrospective review of 51 IS patients with confirmed FCD from 2004-2010.
- Analysis of seizure outcomes based on antiepileptic drug (AED) treatment, ketogenic diet (KD), and resective surgery.
- Correlation of outcomes with individual neuroimaging findings.
Main Results:
- FCD was confirmed in 51 out of 404 IS patients; MRI confirmation of FCD was often delayed beyond 1 year of age.
- Seizure freedom rates were low with additional AEDs (2.3%) once initial treatments failed.
- Ketogenic diet (KD) achieved seizure freedom in 33.3% of patients, while surgery achieved it in 73.3% of medically intractable cases.
Conclusions:
- Ketogenic diet (KD) and resective surgery are effective options for medically refractory infantile spasms (IS) with focal cortical dysplasia (FCD).
- These interventions should be strongly considered when standard AEDs fail to control seizures in this population.
Purpose:
This study sought to evaluate the seizure outcome of infantile spasms (IS) with focal cortical dysplasia (FCD).
Methods:
We retrospectively reviewed infantile spasms patients with FCD from 2004 to 2010. We investigated seizure outcome from antiepileptic drug (AED), ketogenic diet (KD), resective surgery, and analyzed the results according to individual imaging studies.
Results:
Among 404 patients of IS, FCD was confirmed in 51 patients. In retrospective review of brain MRI, only 21 patients (41.2%) were suspected of FCD before 1year of age, but 45 patients (88.2%) became confirmed to FCD by MRI after the age of 1year. Once the spasms were not controlled by 1 or 2 AEDs, the chance of becoming seizure free with additional third or more drugs was very low (2.3%). The seizure free rate was 33.3% (7/21) in patients treated with ketogenic diet, and 73.3% (22/30) in surgical patients, who were both intractable to AEDs. There were no significant differences in seizure free rate in both ketogenic diet and surgical patients, between MRI negative and positive patients prior to 1year of age.
Conclusions:
KD and surgery should be considered in medically refractory IS with FCD.
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