Long-term seizure outcome in pediatric patients with focal cortical dysplasia undergoing tailored and standard surgical resections. (November 2018)

• Record Type: Journal Article
• Authors: Martinez-Lizana, Eva; Fauser, Susanne; Brandt, Armin; Schuler, Elisabeth; Wiegand, Gert; Doostkam, Soroush; San Antonio-Arce, Victoria; Jacobs, Julia; Bast, Thomas; Shah, Mukesch; Zentner, Josef; Schulze-Bonhage, Andreas
• Is Part Of: Seizure. Volume 62(2018)
• Page Start: 66
• Page End: 73
• Publication Date: 2018-11
• Subjects: Focal cortical dysplasia -- Epilepsy surgery -- Children -- Long-term outcome; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2018.09.021
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: Epilepsy surgery in children with FCD is highly effective in both the short and the long term. Tailored resections provide similar seizure control to lobar or multilobar approaches. The surgical outcome is similar in the age range of 1–18 years. A high proportion of patients achieve successful medication discontinuation. The timing of surgery depends on multiple factors, including the severity of the epilepsy and the FCD delineation. 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.