title: Long-term seizure outcome in 211 patients with focal cortical dysplasia.
abstract: OBJECTIVE
  Focal cortical dysplasia (FCD) is currently recognized as the most common cause of neocortical pharmacoresistant epilepsy. Epilepsy surgery has become an increasingly successful treatment option. Herein, the largest patient cohort reported to date is analyzed regarding long-term outcome and factors relevant for long-term seizure control.
  
  
  METHODS
  Two hundred eleven children and adults undergoing epilepsy surgery for histologically proven FCD and a follow-up period of 2-12 years were analyzed regarding the longitudinal course of seizure control, effects of FCD type, localization, magnetic resonance imaging (MRI), timing of surgery, and postoperative antiepileptic treatment.
  
  
  RESULTS
  After 1 year, Engel class I outcome was achieved in 65% of patients and the percentage of seizure-free patients remained stable over the following (up to 12) years. Complete resection of the assumed epileptogenic area, lower age at surgery, and unilobar localization were positive prognostic indicators of long-term seizure freedom. Seizure recurrence was 12% after the first year, whereas 8% achieved late seizure freedom either following additional introduction of antiepileptic drugs (AEDs) (4%), a reoperation (2%), or a running down phenomenon (2%). Thirty-nine percent of patients had a reduction of AED from polytherapy to monotherapy or a complete cessation of AED treatment. Late seizure relapse was seen in nine patients during reduction of AEDs (i.e., in 12% of all patients with AED tapering); in four of them seizures persisted after reestablishment of antiepileptic medication.
  
  
  CONCLUSIONS
  Postoperative long-term seizure outcome was favorable in patients with FCD and remained stable in 80% of patients after the first postoperative year. Several preoperative factors revealed to be predictive for the postoperative outcome and may help in the preoperative counseling of patients with FCD and in the selection of ideal candidates for epilepsy surgery.
authors.affiliation: Epilepsy Center, University of Freiburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Fauser
authors.forename: Charles
authors.initials: C
authors.lastname: Essang
authors.forename: Dirk-Matthias
authors.initials: DM
authors.lastname: Altenmüller
authors.forename: Anke Maren
authors.initials: AM
authors.lastname: Staack
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Steinhoff
authors.forename: Karl
authors.initials: K
authors.lastname: Strobl
authors.forename: Thomas
authors.initials: T
authors.lastname: Bast
authors.forename: Susanne
authors.initials: S
authors.lastname: Schubert-Bast
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stephani
authors.forename: Gert
authors.initials: G
authors.lastname: Wiegand
authors.forename: Marco
authors.initials: M
authors.lastname: Prinz
authors.forename: Armin
authors.initials: A
authors.lastname: Brandt
authors.forename: Josef
authors.initials: J
authors.lastname: Zentner
authors.forename: Andreas
authors.initials: A
authors.lastname: Schulze-Bonhage
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D002540:Cerebral Cortex / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019465:Craniofacial Abnormalities; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000150:complications / Q000473:pathology / Q000601:surgery*; D004827:Epilepsy / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D054220:Malformations of Cortical Development / Q000150:complications / Q000473:pathology / Q000601:surgery*; D065703:Malformations of Cortical Development, Group I / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Antiepileptic drug withdrawal; Focal cortical dysplasia; Long-term outcome; Prognostic factors