Long-term seizure outcome in pediatric patients with focal cortical dysplasia undergoing tailored and standard surgical resections

Abstract

Focal cortical dysplasia (FCD) is the major cause of focal intractable epilepsy in childhood. Here we analyze the factors influencing the success of surgical treatment in a large cohort of children with histologically ascertained FCD. Method: A retrospective study of the effects of FCD type, surgical intervention, and age at surgery in a pediatric cohort. Results: A total of 113 patients (71 male; mean age at surgery 10.3 years; range 0-18) were analyzed; 45 had undergone lesionectomy, 42 lobectomy, 18 multi-lobectomy, and eight hemispherotomy. Complete seizure control (Engel Ia) was achieved in 56% after two years, 52% at five years, and 50% at last follow-up (18-204 months). Resections were more extensive in younger patients (40% of the surgeries affecting more than one lobe in patients aged nine years or younger vs. 22% in patients older than nine years). While resections were more limited in older children, their long-term outcome tended to be superior (42% seizure freedom in patients aged nine years or younger vs. 56% in patients older than nine years). The outcome in FCD I was not significantly inferior to that in FCD II. Conclusions: Our data confirm the long-term efficacy of surgery in children with FCD and epilepsy. An earlier age at surgery within this cohort did not predict a better long-term outcome, but it involved less-tailored surgical approaches. The data suggest that in patients with an unclear extent of the dysplastic area, later resections may offer advantages in terms of the precision of surgical-resection planning.

Focal Cortical Dysplasia in Pediatric Epilepsy

“…However, it is not simple to say "the earlier, the better. " In patients with an unclear extent of EZ, or younger age with high perioperative risk, or low sensitivity of MRI, later resections may offer advantages in terms of precision of surgical-resection planning [92]. Early surgical intervention in drug-resistant epilepsy can support functional plasticity in children.…”

Differences in pediatric and adult epilepsy surgery: A comparison at one center from 1990 to 2014

“…A meta‐analysis of 36 publications (1993‐2012) comprising 1318 children with temporal and 1259 children with extratemporal resections showed seizure freedom rates (Engel class I) of 76% for temporal lobe resections and 56% for extratemporal resections (minimum follow‐up = 12 months) . A detailed study of long‐term outcome in pediatric focal cortical dysplasias was recently published . A comparison of trends between existing pediatric and adult series from different centers is difficult because of potentially divergent catchment areas and inconsistent presurgical, surgical, and postsurgical strategies and assessments.…”

“…16,17 A detailed study of long-term outcome in pediatric focal cortical dysplasias was recently published. 18 A comparison of trends between existing pediatric and adult series from different centers is difficult because of potentially divergent catchment areas and inconsistent presurgical, surgical, and postsurgical strategies and assessments. To bridge this gap, we compared data on presurgical and surgical numbers, epileptogenic pathologies, and outcome in pediatric cases to those in adults from a large-volume presurgical/surgical program, thereby reducing the differences in the basic study population and approach to a minimum.…”

Focal cortical dysplasia: etiology, epileptogenesis, classification, clinical presentation, imaging, and management

“…Martinez-Lizana et al [49] recently showed that FCD type II detectability on MRI is only slightly higher than FCD type I, which contradicts with previous studies [55] reported a significant difference between types, type II being more frequently identified. There are two theories for this shift of frequency, first one is due to the advances in imaging quality and the second one is due to a selection bias, since the MRIidentified lesions are being selected for epilepsy surgery [49].…”