Abstract | PURPOSE: 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.
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Authors | Pavel Krsek, Alena Jahodova, Bruno Maton, Prasanna Jayakar, Patricia Dean, Brandon Korman, Gustavo Rey, Catalina Dunoyer, Harry V Vinters, Trevor Resnick, Michael Duchowny |
Journal | Epilepsia
(Epilepsia)
Vol. 51
Issue 12
Pg. 2440-8
(Dec 2010)
ISSN: 1528-1167 [Electronic] United States |
PMID | 20887366
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Wiley Periodicals, Inc. © 2010 International League Against Epilepsy. |
Topics |
- Adolescent
- Adult
- Brain
(pathology, surgery)
- Cerebral Cortex
(pathology, surgery)
- Child
- Child, Preschool
- Electroencephalography
- Epilepsies, Partial
(diagnosis, pathology, surgery)
- Female
- Hemispherectomy
(methods)
- Humans
- Infant
- Intelligence Tests
- Magnetic Resonance Imaging
(statistics & numerical data)
- Male
- Malformations of Cortical Development
(diagnosis, pathology, surgery)
- Neuropsychological Tests
- Pregnancy
- Prenatal Diagnosis
- Preoperative Care
(methods)
- Risk Factors
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