Eva Martinez-Lizana1, Susanne Fauser2, Armin Brandt3, Elisabeth Schuler4, Gert Wiegand5, Soroush Doostkam6, Victoria San Antonio-Arce7, Julia Jacobs3, Thomas Bast8, Mukesch Shah9, Josef Zentner9, Andreas Schulze-Bonhage3. 1. Dept. of Epileptology, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany. Electronic address: eva.martinez@uniklinik-freiburg.de. 2. Epilepsy Center Bielefeld, Germany. 3. Dept. of Epileptology, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany. 4. Dept. of Pediatric Neurology Heidelberg, Germany. 5. Dept. of Pediatric Neurology, University of Kiel, Kiel, Germany. 6. Faculty of Medicine, University of Freiburg, Germany; Institute of Neuropathology, Medical Center - University of Freiburg, Germany. 7. Dept. of Epileptology, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany; Dept. of Pediatric Neurology, Hospital Sant Joan de Deu, Barcelona, Spain. 8. Faculty of Medicine, University of Freiburg, Germany; Epilepsy Center Kork, Germany. 9. Faculty of Medicine, University of Freiburg, Germany; Dept. Neurosurgery, Medical Center - University of Freiburg, Germany.
Abstract
PURPOSE: Focal cortical dysplasia (FCD) is the major cause of focal intractable epilepsy in childhood. Here we analyze the factors influencing the success of surgical treatment in a large cohort of children with histologically ascertained FCD. METHOD: A retrospective study of the effects of FCD type, surgical intervention, and age at surgery in a pediatric cohort. RESULTS: A total of 113 patients (71 male; mean age at surgery 10.3 years; range 0-18) were analyzed; 45 had undergone lesionectomy, 42 lobectomy, 18 multi-lobectomy, and eight hemispherotomy. Complete seizure control (Engel Ia) was achieved in 56% after two years, 52% at five years, and 50% at last follow-up (18-204 months). Resections were more extensive in younger patients (40% of the surgeries affecting more than one lobe in patients aged nine years or younger vs. 22% in patients older than nine years). While resections were more limited in older children, their long-term outcome tended to be superior (42% seizure freedom in patients aged nine years or younger vs. 56% in patients older than nine years). The outcome in FCD I was not significantly inferior to that in FCD II. CONCLUSIONS: Our data confirm the long-term efficacy of surgery in children with FCD and epilepsy. An earlier age at surgery within this cohort did not predict a better long-term outcome, but it involved less-tailored surgical approaches. The data suggest that in patients with an unclear extent of the dysplastic area, later resections may offer advantages in terms of the precision of surgical-resection planning.
PURPOSE:Focal cortical dysplasia (FCD) is the major cause of focal intractable epilepsy in childhood. Here we analyze the factors influencing the success of surgical treatment in a large cohort of children with histologically ascertained FCD. METHOD: A retrospective study of the effects of FCD type, surgical intervention, and age at surgery in a pediatric cohort. RESULTS: A total of 113 patients (71 male; mean age at surgery 10.3 years; range 0-18) were analyzed; 45 had undergone lesionectomy, 42 lobectomy, 18 multi-lobectomy, and eight hemispherotomy. Complete seizure control (Engel Ia) was achieved in 56% after two years, 52% at five years, and 50% at last follow-up (18-204 months). Resections were more extensive in younger patients (40% of the surgeries affecting more than one lobe in patients aged nine years or younger vs. 22% in patients older than nine years). While resections were more limited in older children, their long-term outcome tended to be superior (42% seizure freedom in patients aged nine years or younger vs. 56% in patients older than nine years). The outcome in FCD I was not significantly inferior to that in FCD II. CONCLUSIONS: Our data confirm the long-term efficacy of surgery in children with FCD and epilepsy. An earlier age at surgery within this cohort did not predict a better long-term outcome, but it involved less-tailored surgical approaches. The data suggest that in patients with an unclear extent of the dysplastic area, later resections may offer advantages in terms of the precision of surgical-resection planning.
Authors: Attila Rácz; Albert J Becker; Carlos M Quesada; Valeri Borger; Hartmut Vatter; Rainer Surges; Christian E Elger Journal: Front Neurol Date: 2021-06-09 Impact factor: 4.003