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Published online before print November 12, 2008, doi:10.1212/01.wnl.0000327825.48731.c3)
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NEUROLOGY 2009;72:211-216
© 2009 American Academy of Neurology

Predictors of surgical outcome and pathologic considerations in focal cortical dysplasia

D. W. Kim, MD, S. K. Lee, MD, PhD, K. Chu, MD, K. I. Park, MD, S. Y. Lee, MD, C. H. Lee, MD, C. K. Chung, MD, PhD, G. Choe, MD, PhD and J. Y. Kim, MD, PhD

From the Department of Neurology (D.W.K.), Konkuk University Medical Center, Seoul; Comprehensive Epilepsy Center (S.K.L., K.C.), Department of Neurology, Seoul National University Hospital; Department of Neurology (K.I.P.), Seoul Paik Hospital, Inje University; Department of Neurology (S.Y.L.), Kangwon National University Hospital, Chuncheon; Departments of Internal Medicine (C.H.L.), Neurosurgery (C.K.C.), and Pathology (G.C.), College of Medicine, Seoul National University; and Department of Neurology (J.Y.K.), Hallym University Sacred Heart Hospital, Pyeongchon, Korea.

Address correspondence and reprint requests to Dr. Sang Kun Lee, Department of Neurology, Seoul National University Hospital, 28, Yongkeun dong, Chongno Ku, Seoul, 110-744, Korea sangunlee{at}dreamwiz.com.

Background: Although surgical resection has been an important alternative treatment for patients with intractable epilepsy related to focal cortical dysplasia (FCD), the prognostic relevance of the degree of pathologic severity is controversial and there has been only limited information regarding the prognostic factors involved in the surgical treatment of refractory epilepsy in patients with FCD.

Methods: We undertook the present study to assess whether the pathologic subtypes of FCD affect surgical outcomes in patients with drug-resistant epilepsy. We also studied the prognostic roles of clinical factors and various diagnostic modalities in the surgical treatment.

Results: A total of 166 consecutive patients were included. By univariate analysis, incomplete resection of epileptogenic area (p < 0.001), mild pathologic features (p = 0.01), and the presence of secondary tonic clonic seizures (2GTCS) (p = 0.05) were associated with poor surgical outcomes. There was a strong tendency for patients with severe pathologic features to have MRI abnormalities (p < 0.001). Incomplete resection of epileptogenic area (p < 0.001) and mild pathologic features (p = 0.02) were poor independent outcome predictors on multivariate analysis. The results of MRI, scalp EEG, fluorodeoxyglucose–PET, and ictal SPECT were not associated with surgical outcomes.

Conclusions: Our study shows that there is a strong tendency for patients with severe pathologic features to have MRI abnormalities, and patients with incomplete resection, mild pathologic features, or the presence of secondary tonic clonic seizures have a high chance of a poorer surgical outcome.

Abbreviations: 2GTCS = secondary tonic clonic seizures; FC = febrile convulsion; FCD = focal cortical dysplasia; FDG = fluorodeoxyglucose; FDG-PET = fluorodeoxyglucose–positron emission tomography; FLE = frontal lobe epilepsy; IED = interictal epileptiform discharge; mMCD = mild malformations of cortical development; nTLE = neocortical temporal lobe epilepsy; OLE = occipital lobe epilepsy; PLE = parietal lobe epilepsy; SPECT = single-photon emission computed tomography.

Editorial, page 206.

See also page 217.

e-Pub ahead of print on November 12, 2008, at www.neurology.org.

Disclosure: The authors report no disclosures.

Received November 21, 2007. Accepted in final form July 14, 2008.


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