Incomplete resection of focal cortical dysplasia is the main predictor of poor postsurgical outcome

P. Krsek, B. Maton, P. Jayakar, P. Dean, B. Korman, Gustavo Rey, C. Dunoyer, E. Pacheco-Jacome, G. Morrison, J. Ragheb, H. V. Vinters, T. Resnick, M. Duchowny

Research output: Contribution to journalArticle

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Abstract

BACKGROUND:: Focal cortical dysplasia (FCD) is recognized as the major cause of focal intractable epilepsy in childhood. Various factors influencing postsurgical seizure outcome in pediatric patients with FCD have been reported. OBJECTIVE:: To analyze different variables in relation to seizure outcome in order to identify prognostic factors for selection of pediatric patients with FCD for epilepsy surgery. METHODS: A cohort of 149 patients with histologically confirmed mild malformations of cortical development or FCD with at least 2 years of postoperative follow-up was retrospectively studied; 113 subjects had at least 5 years of postoperative follow-up. Twenty-eight clinical, EEG, MRI, neuropsychological, surgical, and histopathologic parameters were evaluated. RESULTS: The only significant predictor of surgical success was completeness of surgical resection, defined as complete removal of the structural MRI lesion (if present) and the cortical region exhibiting prominent ictal and interictal abnormalities on intracranial EEG. Unfavorable surgical outcomes are mostly caused by overlap of dysplastic and eloquent cortical regions. There were nonsignificant trends toward better outcomes in patients with normal intelligence, after hemispherectomy and with FCD type II. Other factors such as age at seizure onset, duration of epilepsy, seizure frequency, associated pathologies including hippocampal sclerosis, extent of EEG and MRI abnormalities, as well as extent and localization of resections did not influence outcome. Twenty-five percent of patients changed Engel? For verifications class of seizure outcome after the second postoperative year. CONCLUSIONS:: The ability to define and fully excise the entire region of dysplastic cortex is the most powerful variable influencing outcome in pediatric patients with focal cortical dysplasia.

Original languageEnglish
Pages (from-to)217-223
Number of pages7
JournalNeurology
Volume72
Issue number3
DOIs
StatePublished - Jan 20 2009

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Malformations of Cortical Development
Seizures
Pediatrics
Electroencephalography
Epilepsy
Hemispherectomy
Aptitude
Partial Epilepsy
Sclerosis
Intelligence
Age of Onset
Patient Selection
Stroke
Pathology

ASJC Scopus subject areas

  • Clinical Neurology

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Incomplete resection of focal cortical dysplasia is the main predictor of poor postsurgical outcome. / Krsek, P.; Maton, B.; Jayakar, P.; Dean, P.; Korman, B.; Rey, Gustavo; Dunoyer, C.; Pacheco-Jacome, E.; Morrison, G.; Ragheb, J.; Vinters, H. V.; Resnick, T.; Duchowny, M.

In: Neurology, Vol. 72, No. 3, 20.01.2009, p. 217-223.

Research output: Contribution to journalArticle

Krsek, P, Maton, B, Jayakar, P, Dean, P, Korman, B, Rey, G, Dunoyer, C, Pacheco-Jacome, E, Morrison, G, Ragheb, J, Vinters, HV, Resnick, T & Duchowny, M 2009, 'Incomplete resection of focal cortical dysplasia is the main predictor of poor postsurgical outcome', Neurology, vol. 72, no. 3, pp. 217-223. https://doi.org/10.1212/01.wnl.0000334365.22854.d3
Krsek, P. ; Maton, B. ; Jayakar, P. ; Dean, P. ; Korman, B. ; Rey, Gustavo ; Dunoyer, C. ; Pacheco-Jacome, E. ; Morrison, G. ; Ragheb, J. ; Vinters, H. V. ; Resnick, T. ; Duchowny, M. / Incomplete resection of focal cortical dysplasia is the main predictor of poor postsurgical outcome. In: Neurology. 2009 ; Vol. 72, No. 3. pp. 217-223.
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T1 - Incomplete resection of focal cortical dysplasia is the main predictor of poor postsurgical outcome

AU - Krsek, P.

AU - Maton, B.

AU - Jayakar, P.

AU - Dean, P.

AU - Korman, B.

AU - Rey, Gustavo

AU - Dunoyer, C.

AU - Pacheco-Jacome, E.

AU - Morrison, G.

AU - Ragheb, J.

AU - Vinters, H. V.

AU - Resnick, T.

AU - Duchowny, M.

PY - 2009/1/20

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N2 - BACKGROUND:: Focal cortical dysplasia (FCD) is recognized as the major cause of focal intractable epilepsy in childhood. Various factors influencing postsurgical seizure outcome in pediatric patients with FCD have been reported. OBJECTIVE:: To analyze different variables in relation to seizure outcome in order to identify prognostic factors for selection of pediatric patients with FCD for epilepsy surgery. METHODS: A cohort of 149 patients with histologically confirmed mild malformations of cortical development or FCD with at least 2 years of postoperative follow-up was retrospectively studied; 113 subjects had at least 5 years of postoperative follow-up. Twenty-eight clinical, EEG, MRI, neuropsychological, surgical, and histopathologic parameters were evaluated. RESULTS: The only significant predictor of surgical success was completeness of surgical resection, defined as complete removal of the structural MRI lesion (if present) and the cortical region exhibiting prominent ictal and interictal abnormalities on intracranial EEG. Unfavorable surgical outcomes are mostly caused by overlap of dysplastic and eloquent cortical regions. There were nonsignificant trends toward better outcomes in patients with normal intelligence, after hemispherectomy and with FCD type II. Other factors such as age at seizure onset, duration of epilepsy, seizure frequency, associated pathologies including hippocampal sclerosis, extent of EEG and MRI abnormalities, as well as extent and localization of resections did not influence outcome. Twenty-five percent of patients changed Engel? For verifications class of seizure outcome after the second postoperative year. CONCLUSIONS:: The ability to define and fully excise the entire region of dysplastic cortex is the most powerful variable influencing outcome in pediatric patients with focal cortical dysplasia.

AB - BACKGROUND:: Focal cortical dysplasia (FCD) is recognized as the major cause of focal intractable epilepsy in childhood. Various factors influencing postsurgical seizure outcome in pediatric patients with FCD have been reported. OBJECTIVE:: To analyze different variables in relation to seizure outcome in order to identify prognostic factors for selection of pediatric patients with FCD for epilepsy surgery. METHODS: A cohort of 149 patients with histologically confirmed mild malformations of cortical development or FCD with at least 2 years of postoperative follow-up was retrospectively studied; 113 subjects had at least 5 years of postoperative follow-up. Twenty-eight clinical, EEG, MRI, neuropsychological, surgical, and histopathologic parameters were evaluated. RESULTS: The only significant predictor of surgical success was completeness of surgical resection, defined as complete removal of the structural MRI lesion (if present) and the cortical region exhibiting prominent ictal and interictal abnormalities on intracranial EEG. Unfavorable surgical outcomes are mostly caused by overlap of dysplastic and eloquent cortical regions. There were nonsignificant trends toward better outcomes in patients with normal intelligence, after hemispherectomy and with FCD type II. Other factors such as age at seizure onset, duration of epilepsy, seizure frequency, associated pathologies including hippocampal sclerosis, extent of EEG and MRI abnormalities, as well as extent and localization of resections did not influence outcome. Twenty-five percent of patients changed Engel? For verifications class of seizure outcome after the second postoperative year. CONCLUSIONS:: The ability to define and fully excise the entire region of dysplastic cortex is the most powerful variable influencing outcome in pediatric patients with focal cortical dysplasia.

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