Low-grade focal cortical dysplasia is associated with prenatal and perinatal brain injury

Pavel Krsek, Alena Jahodova, Bruno Maton, Prasanna Jayakar, Patricia Dean, Brandon Korman, Gustavo Rey, Catalina Dunoyer, Harry V. Vinters, Trevor Resnick, Michael Duchowny

Research output: Contribution to journalArticle

31 Scopus citations

Abstract

Purpose: Prenatal and perinatal adverse events are reported to have a pathogenetic role in focal cortical dysplasia (FCD). However, no data are available regarding the prevalence and significance of this association. A cohort of children with significant prenatal and perinatal brain injury and histologically proven mild malformations of cortical development (mMCD) or FCD was analyzed. Methods: We retrospectively evaluated a surgical series of 200 patients with histologically confirmed mMCD/FCD. Combined historical and radiologic inclusion criteria were used to identify patients with prenatal and perinatal risk factors. Electroclinical, imaging, neuropsychological, surgical, histopathologic, and seizure outcome data were reviewed. Results: Prenatal and perinatal insults including severe prematurity, asphyxia, bleeding, hydrocephalus, and stroke occurred in 12.5% of children with mMCD/FCD (n = 25). Their epilepsy was characterized by early seizure onset, high seizure frequency, and absence of seizure control. Patients with significant prenatal and perinatal risk factors had more abnormal neurologic findings, lower intelligence quotient (IQ) scores, and slower background EEG activity than mMCD/FCD subjects without prenatal or perinatal brain injury. MRI evidence of cortical malformations was identified in 74% of patients. Most patients underwent large multilobar resections or hemispherectomies; 54% were seizure-free 2 years after surgery. Histologically "milder" forms of cortical malformations (mMCD and FCD type I) were observed most commonly in our series. Conclusions: Surgically remediable low-grade cortical malformations may occur in children with significant prenatally and perinatally acquired encephalopathies and play an important role in the pathogenesis of their epilepsy. Presurgical detection of dysplastic cortex has important practical consequences for surgical planning.

Original languageEnglish (US)
Pages (from-to)2440-2448
Number of pages9
JournalEpilepsia
Volume51
Issue number12
DOIs
StatePublished - Dec 1 2010

Keywords

  • Cortical dysplasia
  • EEG
  • Epilepsy surgery
  • MRI
  • Neuropsychological assessment

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

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    Krsek, P., Jahodova, A., Maton, B., Jayakar, P., Dean, P., Korman, B., Rey, G., Dunoyer, C., Vinters, H. V., Resnick, T., & Duchowny, M. (2010). Low-grade focal cortical dysplasia is associated with prenatal and perinatal brain injury. Epilepsia, 51(12), 2440-2448. https://doi.org/10.1111/j.1528-1167.2010.02730.x