12 years of pediatric epilepsy surgery – The Vogtareuth experience

Kessler-Uberti, S; Pieper, Tom; Eitel, H; Pascher, B; Hartlieb, Till; Getzinger, T; Karlmeier, A.; Kudernatsch, Manfred; Winkler, PA; Kolodziejczyk, D.; Blümcke, Ingmar; Staudt, M.; Holthausen, Hans

doi:10.1055/s-0031-1274073

Cited by 5 publications

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“…Patients are typically young with early seizure onset, psychomotor retardation, and hemispheric hypoplasia. Seizures are often pharmacoresistant and postoperative seizure control is relatively poor [19,20]. ILAE FCD type Ib results from a disruption of the cortical architecture with respect to the six-layered tangential composition of the neocortex.…”

Section: Ilae Classificationmentioning

confidence: 99%

Classification and pathological characteristics of the cortical dysplasias

Prayson

2014

Childs Nerv Syst

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This short review provides an overview of the issues which account for the varied historical approaches to FCD classification and descriptions of gross pathologic findings associated with FCD and an overview of two more recently developed and widely used schema, the Palmini et al. (Neurology 62: S2-8, 2004) and the International League Against Epilepsy (ILAE) classifications Blumcke et al. Epilepsia 52: 158-174, 2011. The pathologic features of these two approaches will be reviewed and compared, including discussion of their limitations.

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Section: Ilae Classificationmentioning

confidence: 99%

Classification and pathological characteristics of the cortical dysplasias

Prayson

2014

Childs Nerv Syst

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Electro-clinical-pathological correlations in focal cortical dysplasia (FCD) at young ages

et al. 2014

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The prevalence of focal cortical dysplasia (FCD) in pediatric patients with focal epilepsy is not exactly known because authors of publications in which the etiologies of epilepsies are listed, but which are not dealing specifically with epilepsy surgery issues, tend to lump together the many kinds of malformations of cortical development (MCD), of which FCDs, because of their relative frequency, are the most relevant subtypes. Out of 561 patients with MCD (children and adults) operated at centers in Europe who do feed data into the "European Epilepsy Brain Bank," 426 (76 %) had FCD.

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Neuropathologic measurements in focal cortical dysplasias: validation of the ILAE 2011 classification system and diagnostic implications for MRI

et al. 2011

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Focal cortical dysplasias (FCD) which represent a composite group of cortical malformations are increasingly recognized as morphological substrate for severe therapy-refractory epilepsy in children and young adults. However, presurgical evaluation remains challenging as not all FCD variants can be reliably detected by high-resolution magnetic resonance imaging (MRI). Here, we studied a cohort of 52 epilepsy patients with neuropathological evidence for FCD using the 2011 classification of the International League against Epilepsy (ILAE) and systematically analysed those histopathologic features applicable also for MRI diagnostics. Histopathologic parameters included quantitative measurements of cellular profiles, cortical thickness, heterotopic neurons in white matter, and myelination that were compared between FCD subtypes and age-/localization-matched controls (n = 36) using multivariate analysis. Dysmorphic neurons in both FCD Type II variants showed significantly increased diameter of their cell bodies and nuclei. Cortical thickness was also increased with a distinct loss of myelin content specifying FCD Type IIb from IIa. The data further suggested that myelination deficits in FCD Type IIb result from compromised oligodendroglial lineage differentiation and we concluded that the "transmantle sign" is a unique finding in FCD Type IIb. In contrast, FCD Type Ia was characterized by a smaller cortical ribbon and higher neuronal densities, but these parameters failed to reach statistical significance (considering age- and location-dependent variability in controls). All FCD variants showed abnormal grey-white matter boundaries with increased numbers of heterotopic neurons. Similar results were obtained also at deep white matter location. Thus, many FCD variants may indeed escape visual MRI inspection, but suspicious areas with increased or decreased cortical thickness as well as grey-white matter blurring may be uncovered using post-processing protocols of neuroimaging data. The systematic analysis of well-specified histopathological features could be helpful to improve sensitivity and specificity in MRI detection during pre-surgical work-up of patients with drug-resistant focal epilepsies.

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12 years of pediatric epilepsy surgery – The Vogtareuth experience

Cited by 5 publications

References 0 publications

Classification and pathological characteristics of the cortical dysplasias

Classification and pathological characteristics of the cortical dysplasias

Electro-clinical-pathological correlations in focal cortical dysplasia (FCD) at young ages

Neuropathologic measurements in focal cortical dysplasias: validation of the ILAE 2011 classification system and diagnostic implications for MRI

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