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Widespread cerebral structural changes in patients with cortical dysgenesis and epilepsy
S M Sisodiya1, S L Free, J M Stevens
1Epilepsy Research Group, Institute of Neurology, London, UK.
Brain : a Journal of Neurology
|August 1, 1995
Summary
Cerebral cortical dysgenesis (CD) causes refractory epilepsy, often with hidden brain abnormalities beyond visible lesions. This study reveals widespread structural disruption in CD patients, impacting surgical outcomes.
Area of Science:
- Neuroimaging
- Epilepsy Research
- Neuropathology
Background:
- Cerebral cortical dysgenesis (CD) is a leading cause of intractable partial epilepsy.
- Surgical outcomes for CD-related epilepsy are frequently suboptimal, potentially due to undetected diffuse brain abnormalities.
Purpose of the Study:
- To quantitatively analyze MRI scans in patients with CD to identify structural abnormalities beyond visible lesions.
- To investigate the extent and distribution of grey and subcortical matter volume anomalies in CD.
Main Methods:
- Quantitative MRI analysis of regional grey and subcortical matter volumes.
- Comparison of 18 CD patients with 30 healthy controls and 10 patients with hippocampal sclerosis (HS).
Main Results:
- 15 of 18 CD patients exhibited volumetric abnormalities extending beyond visualized lesions.
- 9 of 10 patients with unilateral CD lesions showed abnormalities in the contralateral hemisphere, invisible on standard MRI review.
- No similar abnormalities were found in HS patients, despite comparable epilepsy characteristics.
Conclusions:
- Extensive, often subvisual, structural brain disorganization exists in CD patients with chronic partial epilepsy.
- These widespread abnormalities are intrinsic to CD, not caused by epilepsy duration or severity.
- The findings suggest CD involves more diffuse brain maldevelopment than typically recognized, impacting treatment strategies.