Seizure Freedom in Children With Pathology-Confirmed Focal Cortical Dysplasia.
OBJECTIVE
We evaluated the temporal course of seizure outcome in children with pathology-confirmed focal cortical dysplasia and explored predictors of sustained seizure freedom.


METHODS
We performed a single-center retrospective study of children ≤ 18 years who underwent resective surgery from January 1, 2000 through December 31, 2012 and had pathology-proven focal cortical dysplasia. Surgical outcome was classified as seizure freedom (Engel class I) or seizure recurrence (Engel classes II-IV). Fisher exact and nonparametric Wilcoxon ranksum tests were used, as appropriate. Survival analysis was based on seizure-free outcome. Patients were censored at the time of seizure recurrence or seizure freedom at last follow-up.


RESULTS
Thirty-eight patients were identified (median age at surgery, 6.5 years; median duration of epilepsy, 3.3 years). Median time to last follow-up was 13.5 months (interquartile range, 7-41 months). Twenty patients (53%) were seizure free and 26 patients (68%) attained seizure freedom for a minimum of 3 months. Median time to seizure recurrence was 38 months (95% confidence interval, 6-109 months), and the cumulative seizure-free rate was 60% at 12 months (95% confidence interval, 43%-77%). Clinical features associated with seizure freedom at last follow-up included older age at seizure onset (P = .02), older age at surgery (P = .04), absent to mild intellectual disability before surgery (P = .05), and seizure freedom for a minimum of 3 months (P < .001).


CONCLUSIONS
Favorable clinical features associated with sustained seizure freedom included older age at seizure onset, older age at surgery, absent or mild intellectual disability at baseline, and seizure freedom for a minimum of 3 months.
Division of Child and Adolescent Neurology, Mayo Clinic, Rochester, Minnesota.
Anna
A
Mrelashvili
Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Robert J
RJ
Witte
Division of Child and Adolescent Neurology, Mayo Clinic, Rochester, Minnesota.
Elaine C
EC
Wirrell
Division of Child and Adolescent Neurology, Mayo Clinic, Rochester, Minnesota.
Katherine C
KC
Nickels
Division of Child and Adolescent Neurology, Mayo Clinic, Rochester, Minnesota. Electronic address: wongkisiel.lily@mayo.edu.
Lily C
LC
Wong-Kisiel
D000367:Age Factors; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D054220:Malformations of Cortical Development / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*
epilepsy surgery; focal cortical dysplasia; neuroimaging; pediatric epilepsy; presurgical evaluation; seizure freedom