title: Surgical resection for intractable epilepsy in "double cortex" syndrome yields inadequate results.
abstract: OBJECTIVE
  To analyze the results of surgical treatment of intractable epilepsy in patients with subcortical band heterotopia, or double cortex syndrome, a diffuse neuronal migration disorder.
  
  
  METHODS
  We studied eight patients (five women) with double cortex syndrome and intractable epilepsy. All had a comprehensive presurgical evaluation including prolonged video-EEG recordings and magnetic resonance imaging (MRI).
  
  
  RESULTS
  All patients had partial seizures, with secondary generalization in six of them. Neurologic examination was normal in all. Three were of normal intelligence, and five were mildly retarded. Six patients underwent invasive EEG recordings, three of them with subdural grids and three with stereotactic implanted depth electrodes (SEEG). Although EEG recordings showed multilobar epileptic abnormalities in most patients, regional or focal seizure onset was recorded in all. MRI showed bilateral subcortical band heterotopia, asymmetric in thickness in three. An additional area of cortical thickening in the left frontal lobe was found in one patient. Surgical procedures included multiple subpial transections in two patients, frontal lesionectomy in one, temporal lobectomy with amygdalohippocampectomy in five, and an additional anterior callosotomy in one. Five patients had no significant improvement, two had some improvement, and one was greatly improved.
  
  
  CONCLUSIONS
  Our results do not support focal surgical removal of epileptogenic tissue in patients with double cortex syndrome, even in the presence of a relatively localized epileptogenic area.
authors.affiliation: Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada. andrea@bic.mni.mcgill.ca
authors.forename: A
authors.initials: A
authors.lastname: Bernasconi
authors.forename: V
authors.initials: V
authors.lastname: Martinez
authors.forename: P
authors.initials: P
authors.lastname: Rosa-Neto
authors.forename: D
authors.initials: D
authors.lastname: D'Agostino
authors.forename: N
authors.initials: N
authors.lastname: Bernasconi
authors.forename: S
authors.initials: S
authors.lastname: Berkovic
authors.forename: M
authors.initials: M
authors.lastname: MacKay
authors.forename: A S
authors.initials: AS
authors.lastname: Harvey
authors.forename: A
authors.initials: A
authors.lastname: Palmini
authors.forename: J C
authors.initials: JC
authors.lastname: da Costa
authors.forename: E
authors.initials: E
authors.lastname: Paglioli
authors.forename: H I
authors.initials: HI
authors.lastname: Kim
authors.forename: M
authors.initials: M
authors.lastname: Connolly
authors.forename: A
authors.initials: A
authors.lastname: Olivier
authors.forename: F
authors.initials: F
authors.lastname: Dubeau
authors.forename: E
authors.initials: E
authors.lastname: Andermann
authors.forename: R
authors.initials: R
authors.lastname: Guerrini
authors.forename: W
authors.initials: W
authors.lastname: Whisler
authors.forename: L
authors.initials: L
authors.lastname: de Toledo-Morrell
authors.forename: F
authors.initials: F
authors.lastname: Morrell
authors.forename: F
authors.initials: F
authors.lastname: Andermann
mesh_terms: D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000002:abnormalities* / Q000601:surgery*; D002648:Child; D003337:Corpus Callosum / Q000601:surgery; D004569:Electroencephalography / Q000706:statistics & numerical data; D004828:Epilepsies, Partial / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D004827:Epilepsy / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D017029:Epilepsy, Complex Partial / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009421:Nervous System Malformations / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D013577:Syndrome; D016896:Treatment Outcome