Longitudinal analyses of the surgical outcomes of pediatric epilepsy patients with focal cortical dysplasia.
OBJECTIVE
The long-term surgical outcome of pediatric patients with epilepsy accompanied by focal cortical dysplasia (FCD) is not clear. The authors report on the long-term surgical outcomes of children with FCD, based on longitudinal analyses.


METHODS
The authors retrospectively analyzed the records of 41 children who underwent epilepsy surgery for pathologically proven FCD. Twenty of these patients were male and 21 were female. The median age at surgery was 9 years (range 1-17 years).


RESULTS
The actuarial seizure-free rates were 49, 44, and 33% in the 1st, 2nd, and 5th years after surgery, respectively. There was no seizure recurrence after 3 years. Three patients with initial failure of seizure control experienced late remission of seizures (the so-called running-down phenomenon). Eventually, 19 patients (46%) were seizure free at their last follow-up visit. Absence of a lesion on MR imaging and incomplete resection were significantly associated with seizure-control failure. Concordance of presurgical evaluation data was a marginally significant variable for seizure control in patients with lesional epilepsy. Three patients with seizure-control failure became seizure free as a result of the running-down phenomenon. The actuarial rate of antiepileptic drug discontinuation was 91% in the 5th year in the seizure-free patients.


CONCLUSIONS
The seizure-free rate after surgery in children with FCD was 49% in the 1st year; however, it declined thereafter. The running-down phenomenon could be an important mechanism of seizure alleviation for patients with FCD during long-term follow-up. Because a complete resection of FCD has a strong prognostic implication for seizure control, a better method to define the extent of FCD is required to assist with resection, especially in nonlesional epilepsy.
Phi
Ji Hoon
JH
Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Cho
Byung-Kyu
BK
Wang
Kyu-Chang
KC
Lee
Ji Yeoun
JY
Hwang
Yong Seung
YS
Kim
Ki Joong
KJ
Chae
Jong-Hee
JH
Kim
In-One
IO
Park
Sung-Hye
SH
Kim
Seung-Ki
SK
D000206:Actuarial Analysis; D000293:Adolescent; D000927:Anticonvulsants / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D054220:Malformations of Cortical Development / Q000175:diagnosis / Q000601:surgery*; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D012815:Signal Processing, Computer-Assisted; D015899:Tomography, Emission-Computed, Single-Photon; D017211:Treatment Failure
D000927:Anticonvulsants