title: Clinical, EEG, MRI, MEG, and surgical outcomes of pediatric epilepsy with astrocytic inclusions versus focal cortical dysplasia.
abstract: OBJECTIVE
  Astrocytic inclusions (AIs) have been identified on histologic specimens of patients with early onset seizures, and the proteomic contents have been described. The aim of this study was to compare the clinical, electroencephalography (EEG), magnetoencephalography (MEG), magnetic resonance imaging (MRI), and surgical outcomes of AIs relative to focal cortical dysplasia (FCD).
  
  
  METHODS
  We assessed the clinical manifestations, semiology, ictal and interictal features on video-EEG, MEG, MRI features, and surgical outcomes of children with histologically proven AIs compared to FCD.
  
  
  RESULTS
  Six children had AIs and 27 had FCD. Children with AIs had an earlier age at seizure onset, periodic spasms (all children), and interictal epileptiform discharges consisting of a mixture of generalized or diffuse hemispheric slow waves, sharp waves, spikes and polyspikes. Children with FCD were less likely to have spasms (4/27 [15%]), and the morphology of the diffuse hemispheric or generalized discharges were different from those of AI, consisting of spike-and-waves, polyspike-and-waves, sharp-and-slow waves, and paroxysmal fast activity. Patients with AIs were less likely to have tightly clustered MEG spike sources (3/6 [50%] vs. 23/27 [85%]), and more likely to demonstrate abnormal sulcation and gyration pattern (4/6 [67%] vs. 2/27 [7%]) and gray matter heterotopia (2/6 [33%] vs. 0/27 [0%]) than patients with FCD. Four children with AIs had resection and two had biopsy but did not undergo resection. Children with AIs had lower rates of seizure freedom after surgery compared to FCD (1/4 [25%] vs. 15/27 [56%], respectively).
  
  
  CONCLUSIONS
  Although there were some similarities between AIs and FCD, patients with AIs were more likely to present with early onset periodic spasms, have unusual interictal epileptiform discharges, abnormal sulcation, gyration pattern, and gray matter heterotopia, and were less likely to be seizure free following surgical resection relative to FCD. Further study with a larger sample size is needed to validate our findings.
authors.affiliation: Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Laila
authors.initials: L
authors.lastname: Alshafai
authors.forename: Ayako
authors.initials: A
authors.lastname: Ochi
authors.forename: Cristina
authors.initials: C
authors.lastname: Go
authors.forename: Blathnaid
authors.initials: B
authors.lastname: McCoy
authors.forename: Cynthia
authors.initials: C
authors.lastname: Hawkins
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Otsubo
authors.forename: Orlando C
authors.initials: OC
authors.lastname: Snead
authors.forename: James
authors.initials: J
authors.lastname: Rutka
authors.forename: Elysa
authors.initials: E
authors.lastname: Widjaja
mesh_terms: D001253:Astrocytes / Q000473:pathology*; D001921:Brain / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D015225:Magnetoencephalography; D008297:Male; D054220:Malformations of Cortical Development / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D059906:Neuroimaging
keywords: Astrocytic inclusions; Focal cortical dysplasia; Hemispheric discharges; Pediatric epilepsy; Periodic spasm