title: Epilepsy prevalence and severity predictors in MRI-identified focal cortical dysplasia.
abstract: To determine the prevalence of epilepsy and drug-resistant epilepsy in pediatric patients with focal cortical dysplasia (FCD) identified by magnetic resonance imaging (MRI). To determine clinical and imaging differences between those with drug-resistant epilepsy, drug-responsive epilepsy, and no epilepsy among children with MRI-identified FCD.
  
  
  
  A keyword search of a hospital radiology database identified 97 study participants for inclusion in this retrospective study. Participants were included if they were under 18 years of age at time of database query and had an MRI between 2004 and 2013 showing FCD. Exclusion was based on imaging and clinical characteristics. Data was gathered using a chart review and supplemental questionnaire.
  
  
  
  In this cohort of patients with imaging findings compatible with FCD, 29% had not developed epilepsy. The prevalence of epilepsy and drug-resistant epilepsy was 71.13% (95% C.I.=61.05-79.89%) and 32.99% (95% C.I.=23.78-43.27%), respectively. Patients with epilepsy were more likely to have temporal (p=0.029) or frontal (p=0.044) lobe lesions and a family history of seizures (p=0.003) than those without epilepsy. Age of seizure onset was later in those with drug-responsive epilepsy than those with drug-resistant epilepsy (p=0.0002). A later age of seizure onset (OR=1.22, p=0.0441, 95% C.I.=1.00-1.486) and absence of developmental delay (OR=3.624, p=0.0497, 95% C.I.=1.002-13.110) predicted a less severe epilepsy phenotype.
  
  
  
  Previous studies have only assessed patient cohorts with FCD and epilepsy, limiting the data on "asymptomatic" or "atypically presenting" FCD. Identifying a surprisingly large, novel cohort of children with FCD that had not developed epilepsy helps define prognosis and inform clinical management of children with FCD on imaging.
authors.affiliation: University of Arizona, Tucson, AZ 85721, United States.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Maynard
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; University of Cincinnati, Cincinnati, OH 45220, United States.
authors.forename: James L
authors.initials: JL
authors.lastname: Leach
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; University of Cincinnati, Cincinnati, OH 45220, United States.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Horn
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States.
authors.forename: Christine G
authors.initials: CG
authors.lastname: Spaeth
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; University of Cincinnati, Cincinnati, OH 45220, United States.
authors.forename: Francesco T
authors.initials: FT
authors.lastname: Mangano
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; University of Cincinnati, Cincinnati, OH 45220, United States.
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Holland
authors.affiliation: Nemours Children's Hospital, Orlando, FL 32827, United States.
authors.forename: Lili
authors.initials: L
authors.lastname: Miles
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Faist
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; University of Cincinnati, Cincinnati, OH 45220, United States. Electronic address: hansel.greiner@cchmc.org.
authors.forename: Hansel M
authors.initials: HM
authors.lastname: Greiner
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D054220:Malformations of Cortical Development / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D019635:Neurosurgical Procedures / Q000379:methods; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult
keywords: Epilepsy surgery; Focal cortical dysplasia; Magnetic resonance imaging; Malformation of cortical development; Seizures