title: Surgical treatment of polymicrogyria-related epilepsy.
abstract: The role of resective surgery in the treatment of polymicrogyria (PMG)-related focal epilepsy is uncertain. Our aim was to retrospectively evaluate the seizure outcome in a consecutive series of patients with PMG-related epilepsy who received, or did not receive, surgical treatment, and to outline the clinical characteristics of patients who underwent surgery.
  
  
  
  We evaluated 64 patients with epilepsy associated with magnetic resonance imaging (MRI)-documented PMG. After presurgical evaluation, 32 patients were excluded from surgical treatment and 32 were offered surgery, which was declined by 8 patients. Seizure outcome was assessed in the 40 nonsurgical and 24 surgical patients.
  
  
  
  Of 40 nonsurgical patients, 8 (20%) were seizure-free after a mean follow-up of 91.7 ± (standard deviation) 59.5 months. None of the eight patients who declined surgical treatment was seizure-free (mean follow-up: 74.3 ± 60.6 months). These seizure outcomes differ significantly (p = 0.000005 and p = 0.0003, respectively) from that of the 24 surgical patients, 18 of whom (66.7%) were Engel's class I postoperatively (mean follow-up: 66.5 ± 54.0 months). Of the eight patients excluded from surgery for seizure control at first visit, two had seizure recurrence at last contact. At last contact, antiepileptic drugs (AEDs) had been withdrawn in 6 of 24 surgical and in one of 40 nonsurgical cases (p = 0.0092).
  
  
  
  The present study indicates that, at least in a subset of adequately selected patients with PMG-related epilepsy, surgery may provide excellent seizure outcomes. Furthermore, it suggests that surgery is superior to AEDs for achieving seizure freedom in these cases.
authors: Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy.
authors: Massimo
authors: M
authors: Cossu
authors: Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy.
authors: Veronica
authors: V
authors: Pelliccia
authors: Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy.
authors: Francesca
authors: F
authors: Gozzo
authors: Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy.
authors: Giuseppe
authors: G
authors: Casaceli
authors: Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy.
authors: Stefano
authors: S
authors: Francione
authors: Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy.
authors: Lino
authors: L
authors: Nobili
authors: Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy.
authors: Roberto
authors: R
authors: Mai
authors: Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy.
authors: Laura
authors: L
authors: Castana
authors: Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy.
authors: Ivana
authors: I
authors: Sartori
authors: Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy.
authors: Francesco
authors: F
authors: Cardinale
authors: Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy.
authors: Giorgio
authors: G
authors: Lo Russo
authors: Department of Neuroscience, Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy.
authors: Laura
authors: L
authors: Tassi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D065706:Polymicrogyria / Q000150:complications*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Drug-resistant epilepsy; Epilepsy surgery; Malformation of cortical development; Seizure outcome; Stereo-electroencephalography