title: Identifying subtle cortical gyral abnormalities as a predictor of focal cortical dysplasia and a cure for epilepsy.
abstract: OBJECTIVE
  To highlight a case series of 3 cases of focal cortical dysplasia that were unrecognized for many years though the patients were seen by various neurologists and received the appropriate neuroimaging studies, and to retrospectively characterize the clinical elements, neuroimaging, electroencephalography, and pathologic findings in these cases.
  
  
  METHODS
  Retrospective descriptive study.
  
  
  METHODS
  Tertiary urban and suburban neurology and epilepsy outpatient and inpatient clinic settings and hospitals.
  
  
  METHODS
  We analyze retrospectively 3 patients in whom magnetic resonance images were previously deemed as normal, who, in fact, exhibited subtle gyral abnormalities and who underwent focal surgical resections of these regions after invasive electroencephalography monitoring or electrocorticography and were cured of their epilepsy.
  
  
  METHODS
  Clinical semiology and neuroimaging findings.
  
  
  RESULTS
  Focal cortical dysplasias may present with subtle gyral abnormalities. These gyral abnormalities may guide invasive electroencephalography or electrocorticography and may delineate seizure onsets with precision. Resection of these areas in 3 such patients resulted in excellent surgical outcomes.
  
  
  CONCLUSIONS
  Subtle gyral abnormalities may be associated with intractable epilepsy and seizure onsets. Focal resection after appropriate evaluations in selected patients may be curative. The magnetic resonance imaging features of focal cortical dysplasia can be subtle and require a high index of suspicion based on ictal semiology and clinical presentation.
authors: Tufts University and Lahey Clinic, 41 Mall Rd, Burlington, MA 01805, USA. joel.m.oster@lahey.org
authors: Joel M
authors: JM
authors: Oster
authors: Eme
authors: E
authors: Igbokwe
authors: G Rees
authors: GR
authors: Cosgrove
authors: Andrew J
authors: AJ
authors: Cole
mesh_terms: D000293:Adolescent; D002540:Cerebral Cortex / Q000473:pathology* / Q000601:surgery; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000209:etiology / Q000473:pathology; D004827:Epilepsy / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D054220:Malformations of Cortical Development / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010292:Paresthesia / Q000209:etiology; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000503:physiopathology