Reader Response: Race-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke

Abstract

Dr. Macdonald-Laurs et al. reported 38 patients with bottom-of-sulcus dysplasia (BOSD), who underwent a limited corticectomy and whose seizure outcomes indicated minor neurologic complications, 1 echoing previous literature. 2,3 Although subtle changes can be found from structural MRIs, combined fluorodeoxyglucose (FDG)-positron emission tomography (FDG-PET) and MRI imaging can produce high sensitivity in detecting these small lesions. Because these lesions are well confined, sulcus-centered resections could be considered for better function protection, while also guaranteeing the seizure outcome. 4 The authors implied the outcome of conventional open surgery is similar to that of laser interstitial thermal therapy (LITT). In our recent LITT clinical trial, a subcohort of 7 patients with BOSD was included-6 achieved an Engel IA outcome and 1 an Engel IB outcome, postoperatively, with a mean follow-up of 6 months. In addition, patients were willing to consent to LITT, given its minimally invasive nature. Considering BOSD is mostly located outside the temporal lobe, the traditional viewpoint that extratemporal surgeries are less effective than temporal lobe ones may not apply to this condition. 5 The existing research stems from all retrospective studies-as such, multicenter collaborations could yield high class evidence that may profoundly change the treatment strategies for BOSDs.