title: Developmental outcome after surgery in focal cortical dysplasia patients with early-onset epilepsy.
abstract: The purpose of this study was to investigate the developmental outcome after surgery for early-onset epilepsy in patients with focal cortical dysplasia (FCD). Among 108 patients with histopathologically confirmed FCD operated between 1985 and 2008, we selected 17 patients with epilepsy onset up to 3 years of age. Development was evaluated by the developmental quotient or intelligence quotient (DQ-IQ) and mental age was measured by the Mother-Child Counseling baby test or the Tanaka-Binet scale of intelligence. Postsurgical development outcome was evaluated by the changes in DQ-IQ and mental age as well as rate of increase in mental age (RIMA) after surgery. RIMA was calculated as the increase in mental age per chronological year (months/year; normal average rate: 12 months/year). Age at epilepsy onset of 17 patients ranged from 15 days to 36 months (mean±SD, 11.0±10.0 months). Age at surgery ranged from 18 to 145 months (75.1±32.4 months). Evaluation just before surgery showed that 13 of 17 (76.4%) patients had DQ-IQ below 70. Ten patients (58.8%) were seizure-free throughout the postsurgical follow-up period. After surgery, DQ-IQ was maintained within 10 points of the presurgical level in 13 patients (76.4%), and increased by more than 10 points in one patient (5.9%). After surgery, RIMA in patients with Engel's class I (7.5±3.8) was higher than patients with Engel's class II-IV (2.6±3.4) (unpaired t-test with Welch's correction, t=2.99, df=15, p=0.0092). RIMA was particularly low in two patients with spasm. In four patients with presurgical DQ-IQ<70, seizure-free after surgery and without spasm, DQ-IQ did not increase but RIMA improved from 3.6±2.8 before surgery to 6.9±2.5 months/year after surgery. RIMA became better from 2 years after surgery. In four patients with presurgical DQ-IQ≥70 and no spasm, two showed the same or higher RIMA than normal average after surgery. In 58.8% of FCD patients with early onset epilepsy, epilepsy surgery effectively controlled seizures, and in 82.3% of patients, epilepsy surgery preserved or improved development. Residual seizures after surgery and lower DQ-IQ before surgery might be potential risk factors for poor development after surgery. In patients of Engel's class I with lower presurgical DQ-IQ, catch-up increase in mental age was observed after two years following surgery.
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, NHO, 886 Urushiyama, Aoi-Ku, Shizuoka, Shizuoka, Japan.
authors.forename: Nobusuke
authors.initials: N
authors.lastname: Kimura
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, NHO, 886 Urushiyama, Aoi-Ku, Shizuoka, Shizuoka, Japan. Electronic address: takahashi-ped@umin.ac.jp.
authors.forename: Yukitoshi
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, NHO, 886 Urushiyama, Aoi-Ku, Shizuoka, Shizuoka, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Shigematsu
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, NHO, 886 Urushiyama, Aoi-Ku, Shizuoka, Shizuoka, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Imai
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, NHO, 886 Urushiyama, Aoi-Ku, Shizuoka, Shizuoka, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Ikeda
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, NHO, 886 Urushiyama, Aoi-Ku, Shizuoka, Shizuoka, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ootani
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, NHO, 886 Urushiyama, Aoi-Ku, Shizuoka, Shizuoka, Japan.
authors.forename: Rumiko
authors.initials: R
authors.lastname: Takayama
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, NHO, 886 Urushiyama, Aoi-Ku, Shizuoka, Shizuoka, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Mogami
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, NHO, 886 Urushiyama, Aoi-Ku, Shizuoka, Shizuoka, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Kimura
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, NHO, 886 Urushiyama, Aoi-Ku, Shizuoka, Shizuoka, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Baba
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, NHO, 886 Urushiyama, Aoi-Ku, Shizuoka, Shizuoka, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Matsuda
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, NHO, 886 Urushiyama, Aoi-Ku, Shizuoka, Shizuoka, Japan.
authors.forename: Takayasu
authors.initials: T
authors.lastname: Tottori
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, NHO, 886 Urushiyama, Aoi-Ku, Shizuoka, Shizuoka, Japan.
authors.forename: Naotaka
authors.initials: N
authors.lastname: Usui
authors.affiliation: National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorder, NHO, 886 Urushiyama, Aoi-Ku, Shizuoka, Shizuoka, Japan.
authors.forename: Yushi
authors.initials: Y
authors.lastname: Inoue
mesh_terms: D002648:Child; D002657:Child Development; D002675:Child, Preschool; D004827:Epilepsy / Q000150:complications* / Q000523:psychology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007360:Intelligence; D007361:Intelligence Tests; D008297:Male; D054220:Malformations of Cortical Development / Q000150:complications* / Q000523:psychology; D011581:Psychological Tests; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cognition; Development; Early-onset epilepsy; Focal cortical dysplasia; Pediatric epilepsy surgery