title: Seizure outcome after surgery for epilepsy due to focal cortical dysplastic lesions.
abstract: Neocortical development is a highly complex process encompassing cellular proliferation, neuronal migration and cortical organization. At any time this process can be interrupted or modified by genetic or acquired factors causing malformations of cortical development (MCD). Epileptic seizures are the most common type of clinical manifestation, besides developmental delay and focal neurological deficits. Seizures due to MCD are frequently pharmacoresistant, especially those associated to focal cortical dysplasia (FCD). Surgical therapy results have been reported since 1971, however, currently available data from surgical series are still limited, mainly due to small number of patients, distinct selection of candidates and surgical strategies, variable pathological diagnosis and inadequate follow-up. This study addresses the possibilities of seizure relief following resection of focal cortical dysplasia, and the impact of presurgical evaluation, extent of resection and pathological findings on surgical outcome. We included 41 patients, 22 adults and 19 children and adolescents, with medically intractable seizures operated on from 1996 to 2002. All were submitted to standardized presurgical evaluation including high-resolution MRI, Video-EEG monitoring and ictal SPECT. Post-surgical seizure outcome was classified according to Engel's schema. Univariate and multivariate analysis were performed. Fifteen patients had temporal and 26 extratemporal epilepsies. Of the total 26 patients (63.4%) reached seizure-free status post-operatively. There was no correlation between outcome and age at surgery, duration of epilepsy, frequency of seizures, and pathological findings. There was, however, a clear correlation with topography of FCD (temporal versus extratemporal) and regional ictal EEG onset, on univariate as well as multivariate analysis.
authors.affiliation: Department of Neurology, Psychiatry and Psychology, Ribeirão Preto School of Medicine, University of São Paulo, Brazil.
authors.forename: Veriano
authors.initials: V
authors.lastname: Alexandre
authors.forename: Roger
authors.initials: R
authors.lastname: Walz
authors.forename: Marino M
authors.initials: MM
authors.lastname: Bianchin
authors.forename: Tonicarlo R
authors.initials: TR
authors.lastname: Velasco
authors.forename: Vera C
authors.initials: VC
authors.lastname: Terra-Bustamante
authors.forename: Lauro
authors.initials: L
authors.lastname: Wichert-Ana
authors.forename: David
authors.initials: D
authors.lastname: Araújo
authors.forename: Helio R
authors.initials: HR
authors.lastname: Machado
authors.forename: João A
authors.initials: JA
authors.lastname: Assirati
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Carlotti
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Santos
authors.forename: Luciano N
authors.initials: LN
authors.lastname: Serafini
authors.forename: Américo C
authors.initials: AC
authors.lastname: Sakamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery*; D002648:Child; D004567:Electrodes, Implanted; D004569:Electroencephalography; D004827:Epilepsy / Q000151:congenital / Q000601:surgery*; D006801:Humans; D015999:Multivariate Analysis; D011183:Postoperative Complications; D011300:Preoperative Care; D011379:Prognosis; D012640:Seizures / Q000601:surgery; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014741:Video Recording