Louis Georges Maillard1,2,3, Laura Tassi4, Fabrice Bartolomei5,6, Hélène Catenoix7, François Dubeau8, William Szurhaj9,10, Philippe Kahane11,12,13, Anca Nica14,15, Petr Marusic16, Ioana Mindruta17,18, Francine Chassoux19, Georgia Ramantani1,20,21. 1. Research Center for Automatic Control of Nancy (CRAN), University of Lorraine, CNRS, UMR 7039, Vandoeuvre, France. 2. Department of Neurology, Central University Hospital (CHU) Nancy, Nancy, France. 3. Medical Faculty, University of Lorraine, Nancy, France. 4. "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy. 5. Aix Marseille University, Institute of Systems Neuroscience, Marseille, France. 6. AP-HM, Hospital de la Timone, Department of Clinical Neurophysiology, Marseille, France. 7. Functional Neurology and Epileptology Department, Pierre Wertheimer Neurological Hospital, Lyon, France. 8. Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec, Canada. 9. Epilepsy Unit, Lille University Medical Centre, Lille, France. 10. INSERM U1171, University of Lille, France. 11. Department of Neurology, Central University Hospital, Grenoble, France. 12. INSERM U1216, Grenoble Neuroscience Institute, Grenoble, France. 13. University Grenoble Alpes, Grenoble, France. 14. Neurology Department, CHU, Rennes, France. 15. INSERM, U1099, Rennes, France. 16. Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic. 17. Department of Neurology, University Emergency Hospital, Bucharest, Romania. 18. Department of Neurology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. 19. Department of Neurosurgery, Sainte-Anne Hospital, Paris, France. 20. Child Neurology, University Children's Hospital, Zurich, Switzerland. 21. Swiss Epilepsy Center, Zurich, Switzerland.
Abstract
OBJECTIVE: We aimed to (1) assess the concordance between various polymicrogyria (PMG) types and the associated epileptogenic zone (EZ), as defined by stereoelectroencephalography (SEEG), and (2) determine the postsurgical seizure outcome in PMG-related drug-resistant epilepsy. METHODS: We retrospectively analyzed 58 cases: 49 had SEEG and 39 corticectomy or hemispherotomy. RESULTS: Mean age at SEEG or surgery was 28.3 years (range, 2-50). PMG was bilateral in 9 (16%) patients and unilateral in 49, including 17 (29%) unilobar, 12 (21%) multilobar, 15 (26%) perisylvian, and only 5 (9%) hemispheric. Twenty-eight (48%) patients additionally had schizencephaly, heterotopia, or focal cortical dysplasia. The SEEG-determined EZ was fully concordant with the PMG in only 8 (16%) cases, partially concordant in 74%, and discordant in 10%. The EZ included remote cortical areas in 21 (43%) cases and was primarily localized in those in 5 (10%), all related to the mesial temporal structures. All but 1 PMG patient with corticectomy or hemispherotomy had a unilateral PMG. At last follow-up (mean, 4.6 years; range, 1-16), 28 (72%) patients remained seizure free. Shorter epilepsy duration to surgery was an independent predictor of seizure freedom. INTERPRETATION: PMG-related drug-resistant epilepsy warrants a comprehensive presurgical evaluation, including SEEG investigations in most cases, given that the EZ may only partially overlap with the PMG or include solely remote cortical areas. Seizure freedom is feasible in a large proportion of patients. PMG extent should not deter from exploring the possibility of epilepsy surgery. Our data support the early consideration of epilepsy surgery in this patient group. Ann Neurol 2017;82:781-794.
OBJECTIVE: We aimed to (1) assess the concordance between various polymicrogyria (PMG) types and the associated epileptogenic zone (EZ), as defined by stereoelectroencephalography (SEEG), and (2) determine the postsurgical seizure outcome in PMG-related drug-resistant epilepsy. METHODS: We retrospectively analyzed 58 cases: 49 had SEEG and 39 corticectomy or hemispherotomy. RESULTS: Mean age at SEEG or surgery was 28.3 years (range, 2-50). PMG was bilateral in 9 (16%) patients and unilateral in 49, including 17 (29%) unilobar, 12 (21%) multilobar, 15 (26%) perisylvian, and only 5 (9%) hemispheric. Twenty-eight (48%) patients additionally had schizencephaly, heterotopia, or focal cortical dysplasia. The SEEG-determined EZ was fully concordant with the PMG in only 8 (16%) cases, partially concordant in 74%, and discordant in 10%. The EZ included remote cortical areas in 21 (43%) cases and was primarily localized in those in 5 (10%), all related to the mesial temporal structures. All but 1 PMG patient with corticectomy or hemispherotomy had a unilateral PMG. At last follow-up (mean, 4.6 years; range, 1-16), 28 (72%) patients remained seizure free. Shorter epilepsy duration to surgery was an independent predictor of seizure freedom. INTERPRETATION: PMG-related drug-resistant epilepsy warrants a comprehensive presurgical evaluation, including SEEG investigations in most cases, given that the EZ may only partially overlap with the PMG or include solely remote cortical areas. Seizure freedom is feasible in a large proportion of patients. PMG extent should not deter from exploring the possibility of epilepsy surgery. Our data support the early consideration of epilepsy surgery in this patient group. Ann Neurol 2017;82:781-794.
Authors: Jonathan K Kleen; Benjamin A Speidel; Maxime O Baud; Vikram R Rao; Simon G Ammanuel; Liberty S Hamilton; Edward F Chang; Robert C Knowlton Journal: Epilepsia Date: 2021-02-26 Impact factor: 5.864
Authors: Kenneth N Taylor; Anand A Joshi; Tugba Hirfanoglu; Olesya Grinenko; Ping Liu; Xiaofeng Wang; Jorge A Gonzalez-Martinez; Richard M Leahy; John C Mosher; Dileep R Nair Journal: Epilepsia Open Date: 2021-05-15