| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Department of Neurology (Drs. Edwards, Wyllie, Lüders, Kotagal, Dinner, and Morris), Neuroradiology (Dr. Ruggeri), Neurosurgery (Drs. Bingaman and Comair), and Pathology (Dr. Prayson), the Cleveland Clinic Foundation, OH.
Address correspondence and reprint requests to Dr. Elaine Wyllie, Pediatric Epilepsy Program, Cleveland Clinic Foundation, S51, 9500 Euclid Avenue, Cleveland, OH 44195.
PURPOSE: To explore seizure outcome after surgery for focal epilepsy due to malformation of cortical development (MCD), with focus on the role of MRI.
METHODS: Thirty-five patients who had surgery for intractable focal epilepsy due to MCD identified by preoperative MRI and confirmed by histopathologic analysis of resected tissue were studied. Patients were aged 3 months to 47 years (median, 14 years) at the time of surgery. Duration of follow-up was 1 to 7.9 (mean, 3.4) years.
RESULTS: At latest follow-up, 17 patients (49%) had Engel Class I outcome with no seizures or auras only; eight patients (23%) had Class II outcome, with rare disabling seizures; seven patients (20%) had worthwhile improvement; and three patients (9%) had no improvement. Seizure-free outcome tended to be more frequent among patients who had complete resection of unilateral MCD (excluding hemimegalencephaly) based on postoperative MRI (7/12; 58%), compared with patients with unilateral MCD who had incomplete resection (3/11; 27%), but the difference was not significant. The frequency of seizure-free outcome did not differ significantly between children (8/14; 57%), adolescents (7/15; 47%) or adults (2/6; 33%); between patients who had daily (12/24; 50%), weekly (4/9; 44%), or monthly (1/2; 50%) seizures preoperatively; between patients who had temporal (2/6; 33%) or extratemporal or multilobar resections (14/28; 50%); or between patients who were (9/16; 56%) or were not (8/19; 42%) studied with subdural electrodes. Results for all analyses were similar when analyzed at latest available follow-up or at 1 year after surgery.
CONCLUSIONS: Surgery can offer seizure-free outcome for approximately one half of carefully selected patients with intractable focal epilepsy due to MCD. Complete resection of the MRI-apparent lesion may improve the likelihood for favorable outcome. MRI evidence of hemimegalencephaly or bilateral MCD suggests a low likelihood for postoperative freedom from seizures.
This article has been cited by other articles:
|
|
 |
|
  S. Aubert, F. Wendling, J. Regis, A. McGonigal, D. Figarella-Branger, J.-C. Peragut, N. Girard, P. Chauvel, and F. Bartolomei Local and remote epileptogenicity in focal cortical dysplasias and neurodevelopmental tumours Brain, November 1, 2009; 132(11): 3072 - 3086. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Widjaja, S. Zarei Mahmoodabadi, H. Otsubo, O. C. Snead, S. Holowka, S. Bells, and C. Raybaud Subcortical Alterations in Tissue Microstructure Adjacent to Focal Cortical Dysplasia: Detection at Diffusion-Tensor MR Imaging by Using Magnetoencephalographic Dipole Cluster Localization Radiology, April 1, 2009; 251(1): 206 - 215. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Wyllie, D. K. Lachhwani, A. Gupta, A. Chirla, G. Cosmo, S. Worley, P. Kotagal, P. Ruggieri, and W. E. Bingaman Successful surgery for epilepsy due to early brain lesions despite generalized EEG findings Neurology, July 24, 2007; 69(4): 389 - 397. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K Chapman, E Wyllie, I Najm, P Ruggieri, W Bingaman, J Luders, P Kotagal, D Lachhwani, D Dinner, and H O Luders Seizure outcome after epilepsy surgery in patients with normal preoperative MRI J. Neurol. Neurosurg. Psychiatry, May 1, 2005; 76(5): 710 - 713. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Otsubo, K. Iida, M. Oishi, C. Okuda, A. Ochi, E. Pang, S. K. Weiss, J. T. Rutka, S. H. Chuang, and O. C. Snead III Neurophysiologic Findings of Neuronal Migration Disorders: Intrinsic Epileptogenicity of Focal Cortical Dysplasia on Electroencephalography, Electrocorticography, and Magnetoencephalography J Child Neurol, April 1, 2005; 20(4): 357 - 363. [Abstract] [PDF]
|
|
|
|
|
|
J. A. Lawson, S. Birchansky, E. Pacheco, P. Jayakar, T. J. Resnick, P. Dean, and M. S. Duchowny Distinct clinicopathologic subtypes of cortical dysplasia of Taylor Neurology, January 11, 2005; 64(1): 55 - 61. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. D. D'Agostino, A. Bastos, C. Piras, A. Bernasconi, T. Grisar, V. G. Tsur, J. Snipes, C. Juhasz, H. Chugani, R. Guerrini, et al. Posterior quadrantic dysplasia or hemi-hemimegalencephaly: A characteristic brain malformation Neurology, June 22, 2004; 62(12): 2214 - 2220. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Jonas, S. Nguyen, B. Hu, R. F. Asarnow, C. LoPresti, S. Curtiss, S. de Bode, S. Yudovin, W. D. Shields, H. V. Vinters, et al. Cerebral hemispherectomy: Hospital course, seizure, developmental, language, and motor outcomes Neurology, May 25, 2004; 62(10): 1712 - 1721. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Foldvary-Schaefer, J. Bautista, F. Andermann, G. Cascino, and S. Spencer Focal malformations of cortical development Neurology, March 23, 2004; 62(6_suppl_3): S14 - S19. [Full Text]
|
|
|
|
|
|
H. Otsubo, K. Iida, M. Oishi, C. Okuda, A. Ochi, E. Pang, S. K. Weiss, J. T. Rutka, S. H. Chuang, and O. Carter Snead Neurophysiologic Findings of Neuronal Migration Disorders: Intrinsic Epileptogenicity of Focal Cortical Dysplasia on Electroencephalography, Electrocorticography, and Magnetoencephalography J Child Neurol, March 1, 2004; 19(3): 357 - 363. [Abstract] [PDF]
|
|
|
|
|
|
S Francione, P Vigliano, L Tassi, F Cardinale, R Mai, G Lo Russo, and C Munari Surgery for drug resistant partial epilepsy in children with focal cortical dysplasia: anatomical-clinical correlations and neurophysiological data in 10 patients J. Neurol. Neurosurg. Psychiatry, November 1, 2003; 74(11): 1493 - 1501. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Devlin, J. H. Cross, W. Harkness, W. K. Chong, B. Harding, F. Vargha-Khadem, and B. G. R. Neville Clinical outcomes of hemispherectomy for epilepsy in childhood and adolescence Brain, March 1, 2003; 126(3): 556 - 566. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Buchhalter and R. G. Jarrar Therapeutics in Pediatric Epilepsy, Part 2: Epilepsy Surgery and Vagus Nerve Stimulation Mayo Clin. Proc., March 1, 2003; 78(3): 371 - 378. [Abstract] [PDF]
|
|
|
|
|
|
C. Bocti, Y. Robitaille, P. Diadori, A. Lortie, C. Mercier, A. Bouthillier, and L. Carmant The pathological basis of temporal lobe epilepsy in childhood Neurology, January 28, 2003; 60(2): 191 - 195. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Boesebeck, R. Schulz, T. May, and A. Ebner Lateralizing semiology predicts the seizure outcome after epilepsy surgery in the posterior cortex Brain, October 1, 2002; 125(10): 2320 - 2331. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Akai, H. Otsubo, E. W. Pang, J. T. Rutka, S. Chitoku, S. K. Weiss, and O. C. Snead Complex Central Cortex in Pediatric Patients With Malformations of Cortical Development J Child Neurol, May 1, 2002; 17(5): 347 - 352. [Abstract] [PDF]
|
|
|
|
|
|
A. Ochi, H. Otsubo, R. Sharma, I. Elliott, J. T. Rutka, S. H. Chuang, K.-i. Kamijo, T. Kiyuna, T. Yamazaki, and O. C. Snead Electroencephalographic Dipoles of Spikes With and Without Myoclonic Jerks Caused by Epilepsia Partialis Continua J Child Neurol, February 1, 2002; 17(2): 127 - 131. [Abstract] [PDF]
|
|
|
|
 |
|
 Outcome After Epilepsy Surgery in Patients with MCD: One Center's Experience Journal Watch Neurology, January 31, 2001; 2001(131): 8 - 8. [Full Text]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
