title: Neuroimaging in identifying focal cortical dysplasia and prognostic factors in pediatric and adolescent epilepsy surgery.
abstract: OBJECTIVE
  The purpose of this study is to determine the sensibility of each imaging tool in identifying focal cortical dysplasia (FCD) in children and adolescents with epilepsy and to define the prognostic factors of pediatric and adolescent epilepsy surgery.
  
  
  METHODS
  We identified 48 children with FCD who underwent resective surgery and analyzed their preoperative data. The results of various anatomic and functional neuroimaging studies were compared for accuracy in locating the lesion. We also investigated clinical factors that affected the outcome of surgical treatment.
  
  
  RESULTS
  Brain magnetic resonance imaging (MRI) was able to localize FCD in 30 patients and fluorodeoxyglucose positron emission tomography (FDG-PET) and/or subtraction ictal single photon emission computed tomography (SPECT) coregistered with MRI provided additional information that helped to define the lesion in 13 patients. When comparing the pathologic results between a mild malformation of cortical development (MCD) and FCD type I and II, we noted a strong tendency for patients with FCD to have MRI abnormalities (p = 0.005). In addition, severe pathologic features (Palmini's classification, FCD type II) (p = 0.025) showed significant correlation with a better surgical outcome. To define the primary epileptogenic area, various interictal epileptiform discharges and the results of multimodal neuroimaging studies were helpful, and younger age at the time of operation could aid in more favorable surgical outcomes (p = 0.048).
  
  
  CONCLUSIONS
  Our study showed a significant relationship between pathologic grade and the detectability of FCD by brain MRI. In addition, early surgery can be justified by showing that advanced neuroimaging studies in children with FCD and even with extensive epileptiform discharges have a higher rate of success.
authors.affiliation: Department of Pediatrics, Pediatric Epilepsy Clinics, Severance Children's Hospital, Epilepsy Research Center, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yoon Hee
authors.initials: YH
authors.lastname: Kim
authors.forename: Hoon-Chul
authors.initials: HC
authors.lastname: Kang
authors.forename: Dong-Seok
authors.initials: DS
authors.lastname: Kim
authors.forename: Se Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Kyu-Won
authors.initials: KW
authors.lastname: Shim
authors.forename: Heung Dong
authors.initials: HD
authors.lastname: Kim
authors.forename: Joon Soo
authors.initials: JS
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D001927:Brain Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D001931:Brain Mapping / Q000379:methods; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D054220:Malformations of Cortical Development / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D065703:Malformations of Cortical Development, Group I; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D055815:Young Adult