title: Cognitive and epilepsy outcomes after epilepsy surgery caused by focal cortical dysplasia in children: early intervention maybe better.
abstract: BACKGROUND
  Focal cortical dysplasia (FCD) is a specific malformation of cortical development harboring intrinsic epileptogenicity, and most of the patients develop drug-resistant epilepsy in early childhood. The detrimental effects of early and frequent seizures on cognitive function in children are significant clinical issues. In this study, we evaluate the effects of early surgical intervention of FCD on epilepsy outcome and cognitive development.
  
  
  METHODS
  From 2006 to 2013, 30 children younger than 18 years old underwent resective surgery for FCDs at Taipei Veterans General Hospital. The mean age at surgery was 10.0 years (range 1.7 to 17.6 years). There were 21 boys and 9 girls. In this retrospective clinical study, seizure outcome, cognitive function, and quality of life were evaluated. To evaluate the effects to outcomes on early interventions, the patients were categorized into four groups according to age of seizure onset, duration of seizure before surgery, and severity of cognitive deficits.
  
  
  RESULTS
  Eleven of 22 (50 %) patients demonstrated developmental delay preoperatively. The Engel seizure outcome achievements were class I in 21 (70 %), class II in 2 (7 %), class III in 6 (20 %), and class IV in 1 (3 %) patients. The locations of FCDs resected were in the frontal lobe in 18 cases, temporal lobe in 7, parietal lobe in 2, and in bilobes including frontoparietal lobe in 2 and parieto-occipital lobes in 1. Eight cases that had FCDs involved in the rolandic cortex presented hemiparesis before surgical resection. Motor function in four of them improved after operation. The histopathological types of FCDs were type Ia in 1, type Ib in 7, type IIa in 7, type IIb in 12, and type III in 3 patients. FCDs were completely resected in 20 patients. Eighteen (90 %) of them were seizure free (p < 0.001) with three patients that received more than one surgery to accomplish complete resection. The patients who had early seizure onset, no significant cognitive function deficit, and early surgical intervention with complete resection in less than 2 years of seizure duration showed best outcomes on seizure control, cognitive function, and quality of life.
  
  
  CONCLUSIONS
  Delay in cognitive development and poor quality of life is common in children treated for FCDs. Early surgical intervention and complete resection of the lesion help for a better seizure control, cognitive function development, and quality of life. FCDs involved eloquent cortex may not prohibit complete resection for better outcomes.
authors.affiliation: Department of Neurosurgery, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, roberthhchen3@gmail.com.
authors.forename: Hsin-Hung
authors.initials: HH
authors.lastname: Chen
authors.forename: Chien
authors.initials: C
authors.lastname: Chen
authors.forename: Sheng-Che
authors.initials: SC
authors.lastname: Hung
authors.forename: Sheng-Yuan
authors.initials: SY
authors.lastname: Liang
authors.forename: Shih-Chieh
authors.initials: SC
authors.lastname: Lin
authors.forename: Ting-Rong
authors.initials: TR
authors.lastname: Hsu
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Yeh
authors.forename: Hsiang-Yu
authors.initials: HY
authors.lastname: Yu
authors.forename: Chun-Fu
authors.initials: CF
authors.lastname: Lin
authors.forename: Sanford P C
authors.initials: SP
authors.lastname: Hsu
authors.forename: Muh-Lii
authors.initials: ML
authors.lastname: Liang
authors.forename: Tsui-Fen
authors.initials: TF
authors.lastname: Yang
authors.forename: Lee-Shing
authors.initials: LS
authors.lastname: Chu
authors.forename: Yung-Yang
authors.initials: YY
authors.lastname: Lin
authors.forename: Kai-Ping
authors.initials: KP
authors.lastname: Chang
authors.forename: Shang-Yeong
authors.initials: SY
authors.lastname: Kwan
authors.forename: Donald M
authors.initials: DM
authors.lastname: Ho
authors.forename: Tai-Tong
authors.initials: TT
authors.lastname: Wong
authors.forename: Yang-Hsin
authors.initials: YH
authors.lastname: Shih
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation* / Q000601:surgery*; D002658:Developmental Disabilities / Q000601:surgery; D018479:Early Intervention, Educational; D004827:Epilepsy / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D054220:Malformations of Cortical Development / Q000150:complications / Q000523:psychology; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000379:methods*; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome