Medically intractable epilepsy in Sturge-Weber syndrome is associated with cortical malformation: implications for surgical therapy.
OBJECTIVE
Anecdotal reports have described cortical malformations in epileptic patients with Sturge-Weber syndrome (SWS). No data are available regarding the prevalence and significance of this association.


METHODS
We reviewed retrospectively the clinical profile, preoperative magnetic resonance imaging (MRI) studies, and pathology reports of all patients with SWS and medically intractable epilepsy evaluated in our epilepsy surgery program between 1979 and 2006.


RESULTS
Twelve patients (male/female = 7/5) were identified. Mean age at seizure onset was 11.1 +/- 16.7 months. Seizures occurred daily in seven patients and weekly in five patients. A facial port-wine stain was noted in 10 cases. Eleven patients evidenced developmental delay and eight were hemiparetic. Eight patients underwent excisional surgery for epilepsy (mean age 10.3 +/- 6.5 year), including hemispherectomy (n = 4) and focal cortical resection (n = 4). Tissue was available for neuropathology in six operated cases and revealed polymicrogyria (n = 3) and cortical dysplasia (n = 4). Polymicrogyria was associated with cortical dysplasia in one child. Brain MRIs were reviewed in 10 of 12 patients and were consistent with cortical malformations in all cases.


CONCLUSIONS
We conclude that cortical malformations are frequent in patients with medically intractable epilepsy and Sturge-Weber-syndrome and may be the primary cause of epilepsy.
Maton
Bruno
B
Miami Children's Hospital, The Brain Institute, Miami, Florida 33155-4079, USA.
Krsek
Pavel
P
Jayakar
Prasanna
P
Resnick
Trevor
T
Koehn
Monica
M
Morrison
Glenn
G
Ragheb
John
J
Castellano-Sanchez
Amilcar
A
Duchowny
Michael
M
D001931:Brain Mapping; D002540:Cerebral Cortex / Q000002:abnormalities* / Q000601:surgery; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D038421:Hemispherectomy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D054220:Malformations of Cortical Development / Q000175:diagnosis / Q000601:surgery; D009483:Neuropsychological Tests; D011300:Preoperative Care; D011379:Prognosis; D013341:Sturge-Weber Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed