title: Focal cortical dysplasia and intractable epilepsy in adults: clinical, EEG, imaging, and surgical features.
abstract: OBJECTIVE
  The clinical features of focal cortical dysplasia (FCD) in adults are poorly understood. The purpose of this report is to describe the clinical, electrographic, and neuroimaging characteristics of adults with FCD undergoing surgical resection for intractable epilepsy.
  
  
  METHODS
  Case series of 55 patients, aged 17-57 years, with a histopathological diagnosis of FCD. Medical history, neurological examination, non-invasive video-EEG, neuroimaging, and surgical outcome data were analyzed retrospectively.
  
  
  RESULTS
  There were 36 patients with temporal, 19 with extra-temporal lobe resections. Mean age at surgery was 29 years. Mean age at epilepsy onset was 10 years. Dual pathology was seen in 56% of patients, with 68% of these having hippocampal sclerosis (HS). Epilepsy risk factors included febrile seizures (16%), head trauma (16%), CNS infections (11%), and perinatal stroke (4%). Interictal EEG showed regional epileptiform activity in 89% of patients. Only 24% were diagnosed with FCD pre-operatively. Of those with dual pathology, only 6% were suspected of having FCD pre-operatively. Of those patients with >12 months follow-up, surgical outcomes were as follows: 65% seizure-free, 19% significant improvement, 16% without significant improvement.
  
  
  CONCLUSIONS
  In this series of adult patients with intractable epilepsy and FCD, a significant number have other seizure risk factors, normal neurological examinations and neuroimaging, and regional EEG findings. Dual pathology was common in patients with FCD. FCD should be considered as an etiology of epilepsy even in patients whose evaluation suggests other mechanisms.
authors.affiliation: Department of Neurology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk S51, Cleveland, OH 44195, USA. bautisj@ccf.org
authors.forename: Jocelyn F
authors.initials: JF
authors.lastname: Bautista
authors.forename: Nancy
authors.initials: N
authors.lastname: Foldvary-Schaefer
authors.forename: William E
authors.initials: WE
authors.lastname: Bingaman
authors.forename: Hans O
authors.initials: HO
authors.lastname: Lüders
mesh_terms: D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000473:pathology* / Q000601:surgery*; D016009:Chi-Square Distribution; D003952:Diagnostic Imaging / Q000379:methods; D004569:Electroencephalography / Q000379:methods*; D004828:Epilepsies, Partial / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies