Surgical outcome of cortical dysplasias presenting with chronic intractable epilepsy: a 10-year experience.
BACKGROUND
There has been sparse description of cortical dysplasias (CDs) causing intractable epilepsy from India.


OBJECTIVE
Clinical retrospective study of CDs causing intractable epilepsy that underwent surgery.


METHODS
Fifty-seven cases of CDs reviewed (1995 till July 2006) are presented. All patients had intractable epilepsy, and underwent a complete epilepsy surgery workup (inter ictal electroencephalography (EEG), video EEG, MRI as per epilepsy protocol, SPECT {interictal, ictal with subtraction and co-registration when required}, and PET when necessary). Surgical treatment included a wide exposure of the pathology with a detailed electrocorticography under optimal anesthetic conditions. Mapping of the sensori-motor area was performed where indicated. Procedures included resection either alone or combined with multiple subpial transactions when extending into the eloquent areas.


RESULTS
Our study had 28 (49.12%) cases of isolated focal CDs, and 29 (50.67%) with dual pathology. Average age at the time of onset of seizures in our series was 7.04 years (three months to 24 years), and average age at the time of surgery was 10.97 years (eight months to 45 years). Among coexistent pathologies, one had associated MTS, 16 had coexistent gangliogliomas and 12 (dysembryonic neuroepithelial tumor) DNTs. At an average follow-up of 3.035 years (range 5-10 years), three patients were lost to follow-up. Fifty-one per cent (29/57) patients had a good outcome (Engel Grade I) and 26%(15/57) had a Grade II outcome.


CONCLUSIONS
Cortical dysplasias have a good outcome if evaluated and managed with concordant electrical and imaging modalities.
Tripathi
Manjari
M
Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Singh
Mahendra S
MS
Padma
M V
MV
Gaikwad
Shailesh
S
Bal
C S
CS
Tripathi
Madhavi
M
Sarkar
C
C
Gupta
Aditya
A
Shukla
Garima
G
Singh
V P
VP
Jain
Satish
S
Sharma
Bhawani S
BS
Chandra
P Sarat
PS
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D005260:Female; D038421:Hemispherectomy / Q000379:methods*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D054220:Malformations of Cortical Development / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult