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Seizure. 2018 Nov;62:66-73. doi: 10.1016/j.seizure.2018.09.021. Epub 2018 Sep 26.

Long-term seizure outcome in pediatric patients with focal cortical dysplasia undergoing tailored and standard surgical resections.

Author information

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.

KEYWORDS:

Children; Epilepsy surgery; Focal cortical dysplasia; Long-term outcome

PMID:
30296740
DOI:
10.1016/j.seizure.2018.09.021
[Indexed for MEDLINE]

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