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Updated: Mar 13, 2026
Author Spotlight: Studying Clinical Characters and Epilepsy Outcomes After Frontal Disconnection in Patients with MOGHE
Published on: August 16, 2024
Surgical treatment of polymicrogyria-related epilepsy
Massimo Cossu1, Veronica Pelliccia1, Francesca Gozzo1
1Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy.
Objective:
The role of resective surgery in the treatment of polymicrogyria (PMG)-related focal epilepsy is uncertain. Our aim was to retrospectively evaluate the seizure outcome in a consecutive series of patients with PMG-related epilepsy who received, or did not receive, surgical treatment, and to outline the clinical characteristics of patients who underwent surgery.
Methods:
We evaluated 64 patients with epilepsy associated with magnetic resonance imaging (MRI)-documented PMG. After presurgical evaluation, 32 patients were excluded from surgical treatment and 32 were offered surgery, which was declined by 8 patients. Seizure outcome was assessed in the 40 nonsurgical and 24 surgical patients.
Results:
Of 40 nonsurgical patients, 8 (20%) were seizure-free after a mean follow-up of 91.7 ± (standard deviation) 59.5 months. None of the eight patients who declined surgical treatment was seizure-free (mean follow-up: 74.3 ± 60.6 months). These seizure outcomes differ significantly (p = 0.000005 and p = 0.0003, respectively) from that of the 24 surgical patients, 18 of whom (66.7%) were Engel's class I postoperatively (mean follow-up: 66.5 ± 54.0 months). Of the eight patients excluded from surgery for seizure control at first visit, two had seizure recurrence at last contact. At last contact, antiepileptic drugs (AEDs) had been withdrawn in 6 of 24 surgical and in one of 40 nonsurgical cases (p = 0.0092).
Significance:
The present study indicates that, at least in a subset of adequately selected patients with PMG-related epilepsy, surgery may provide excellent seizure outcomes. Furthermore, it suggests that surgery is superior to AEDs for achieving seizure freedom in these cases.
Insights
Resective surgery significantly improves seizure freedom in select patients with polymicrogyria (PMG)-related epilepsy compared to medication alone. Surgical intervention offers a superior outcome for achieving seizure control in these challenging cases.
Area of Science:
- Neurology
- Neurosurgery
- Epileptology
Background:
- Polymicrogyria (PMG) is a cortical malformation associated with focal epilepsy, where the efficacy of resective surgery remains unclear.
- Epilepsy linked to PMG presents a significant clinical challenge, necessitating evaluation of treatment modalities.
Purpose of the Study:
- To retrospectively assess seizure outcomes in patients with PMG-related epilepsy who underwent or did not undergo surgical treatment.
- To identify clinical characteristics of patients suitable for surgical intervention in PMG-related epilepsy.
Main Methods:
- Evaluation of 64 patients with MRI-documented PMG and epilepsy.
- Comparison of seizure outcomes between 24 surgical patients and 40 nonsurgical patients (including 8 who declined surgery).
Main Results:
- 18 of 24 surgical patients (66.7%) achieved Engel's class I seizure freedom postoperatively.
- Only 20% of nonsurgical patients were seizure-free, with none of those declining surgery achieving seizure freedom.
- Antiepileptic drug withdrawal was more frequent in surgical patients (p=0.0092).
Conclusions:
- Resective surgery can yield excellent seizure outcomes in a selected group of patients with PMG-related epilepsy.
- Surgical treatment demonstrates superiority over antiepileptic drugs for achieving seizure freedom in these patients.
