Assessment and surgical outcomes for mild type I and severe type II cortical dysplasia: A critical review and the UCLA experience

Lerner, Jason T.; Salamon, Noriko; Hauptman, Jason S.; Velasco, Tonicarlo Rodrigues; Hemb, Marta; Wu, Joyce; Sankar, Raman; Shields, W. Donald; Engel, Jerome; Fried, Itzhak; Cepeda, Carlos; André, Véronique; Levine, Michael S.; Miyata, Hajime; Yong, William H.; Vinters, Harry V.; Mathern, Gary W.

doi:10.1111/j.1528-1167.2008.01998.x

Cited by 352 publications

(382 citation statements)

References 127 publications

(241 reference statements)

Supporting

Mentioning

296

Contrasting

Unclassified

Order By: Relevance

“…Other authors 15 reached similar results when they showed that after complete resection, 80% of patients are seizure free compared with 20% with incomplete resections. Compared with Type I, patients with FCD Type II present at younger ages, have higher seizure frequencies, and are extratemporal.…”

Section: Malformations Due To Abnormal Neuronal and Glial Proliferatisupporting

confidence: 65%

Malformations of cortical development

Guerreiro

2009

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

-Malformations of cortical development (MCD) have been increasingly identified. The purpose of this presentation is to review the current knowledge of the MCD. Before we address this issue, we will briefly present a review of cortical development. The second part of this presentation will address the most important MCD. Finally, the last part of this presentation will address the correlation between MCD and epilepsy.KEY WORDS: malformations of cortical development, focal cortical dysplasias, neuronal migration disorders, cortical organization disorders. Malformações do desenvolvimento corticalResumo -As malformações do desenvolvimento cortical (MDC) são cada vez mais identificadas e diagnosticadas. O propósito desta apresentação é rever o conhecimento recente sobre as MDC. Antes de abordarmos o assunto em questão, apresentaremos brevemente uma revisão sobre a formação cortical. A seguir, abordaremos as principais entidades compreendidas dentro da classificação das MDC e, finalmente, resumiremos a correlação entre MDC e epilepsia.PALAVRAS-CHAVE: malformações do desenvolvimento cortical, displasias corticais focais, distúrbios da migração neuronal, distúrbios da organização cortical. Malformations of cortical development (MCD) have been increasingly identified as a major cause of several disorders, particularly in childhood. Patients with MCD present with a wide spectrum of clinical manifestations ranging from asymptomatic cases to those with epilepsy and neurodevelopmental problems. The advent of the magnetic resonance imaging (MRI) has been the most important factor in the improvement of the diagnosis, which has allowed a better clinical management. Structural imaging has become more sensitive with developments of MRI hardware, acquisition and postprocessing methods.The purpose of this presentation is to review the current knowledge of MCD. Before we address this issue, we will briefly present a review of cortical development. The second part of this presentation will address the most important MCD. Finally, the last part of this presentation will address the correlation between MCD and epilepsy. Barkovich et al. 1 proposed a classification of the malformations of cortical development, taking into account pathological, genetic and neuroimaging features of the different stages of development. They state that there are three main consecutive stages of cortical development, each of them partially overlapping with the previous stage. They are: cellular proliferation and differentiation, neuronal migration, and cortical organization. CORTICAL DEVELOPMENTThe first step of cortical development is cellular proliferation and differentiation, which takes place between the 5 th week and 20 th week of gestation. The germinal or primordial cell multiplies and differentiates becoming either a neuron or glial cell. A general rule of the developing nervous system is that a cell is generated in a different location from its final position in the central nervous system (CNS). The process of changing position from birth ...

show abstract

Section: Malformations Due To Abnormal Neuronal and Glial Proliferatisupporting

confidence: 65%

Malformations of cortical development

Guerreiro

2009

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

show abstract

“…4 Using these classification systems, differences in clinical behavior, imaging appearance, and outcomes have been identified among CD subtypes. 4,19 These findings have significant implications for improving/developing diagnostic techniques to assist in patient selection for surgical therapy. Multiple dysplasia types in one patient have been rarely described, 9 but may not be evident, unless spatially distant resections are performed, and pathologically analyzed.…”

mentioning

confidence: 99%

Magnetic resonance imaging abnormalities in the resection region correlate with histopathological type, gliosis extent, and postoperative outcome in pediatric cortical dysplasia

Leach¹,

Miles²,

Henkel³

et al. 2014

PED

View full text Add to dashboard Cite

Object The authors conducted a study to correlate histopathological features, MRI findings, and postsurgical outcomes in children with cortical dysplasia (CD) by performing a novel resection site–specific evaluation. Methods The study cohort comprised 43 children with intractable epilepsy and CD. The MR image review was blinded to pathology but with knowledge of the resection location. An MRI score (range 0–7) was calculated for each resection region based on the number of imaging features of CD and was classified as “lesional” or “nonlesional” according to all imaging features. Outcome was determined using the International League Against Epilepsy (ILAE) scale. The determination of pathological CD type was based on the ILAE 2011 consensus classification system, and the cortical gliosis pattern was assessed on GFAP staining. Results There were 89 resection regions (50 ILAE Type I, 29 Type IIa, and 10 Type IIb). Eleven (25.6%) of 43 children had more than one type of CD. The authors observed MRI abnormalities in 63% of patients, characteristic enough to direct resection (lesional) in 42%. Most MRI features, MRI score ≥ 3, and lesional abnormalities were more common in patients with Type II CD. Increased cortical signal was more common in those with Type IIb (70%) rather than Type IIa (17.2%) CD (p = 0.004). A good outcome was demonstrated in 39% of children with Type I CD and 72% of those with Type II CD (61% in Type IIa and 100% in Type IIb) (p = 0.03). A lesional MRI abnormality and an MRI score greater than 3 correlated with good outcome in 78% and 90% of patients, respectively (p < 0.03). Diffuse cortical gliosis was more prevalent in Type II CD and in resection regions exhibiting MRI abnormalities. Complete surgical exclusion of the MRI abnormality was associated with a better postoperative outcome. Conclusions This study provides a detailed correlation of MRI findings, neuropathological features, and outcomes in children with intractable epilepsy by using a novel resection site–specific evaluation. Because 25% of the patients had multiple CD subtypes, a regional analysis approach was mandated. Those children with lesional MRI abnormalities, Type II CD, and surgical exclusion of the MRI abnormality had better outcomes. Type II CD is more detectable by MRI than other types, partly because of the greater extent of associated gliosis in Type II. Although MRI findings were correlated with the pathological CD type and outcome in this study, the majority of patients (58%) did not have MRI findings that could direct surgical therapy, underscoring the need for improved MRI techniques for detection and for the continued use of multimodal evaluation methods in patient selection.

show abstract

“…As mentioned by other authors [5,6,22,26], FCD is associated with a wide range of clinical presentations. There is no particular seizure semiology that characterizes patients with FCD compared with other surgical series of epilepsy patients [16][17][18]. There are no distinctive interictal or ictal scalp EEG features that are exclusively associated with FCD.…”

Section: Discussionmentioning

confidence: 94%

“…One possible explanation for these findings, including the two free seizure patients, may be a different selection criterion, since most of the published series are surgical [16,17].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Features of a Series of Non-Surgical Patients with Focal Cortical Dysplasia and Epilepsy

Seifer¹

2014

AJPN

View full text Add to dashboard Cite

Abstract:Most published series of patients with focal cortical dysplasia and epilepsy are surgical or pathological series of pediatric cases. Patients have a high frequency of seizure. The description of clinical features and the frequency patterns of non-surgical adult patients are less describe. We retrospectively reviewed the clinical records of adult patients (>18 years of age) that visited the Epilepsy Centre of the Ramos Mejía Hospital in the city of Buenos Aires between 2010 and 2012. We included all cases with confirmed diagnosis of epilepsy and MRI diagnosis of focal cortical dysplasia by standardized 1.5 T MRI. We analyzed the following variables: sex, age at seizure onset, seizure types, seizure frequency, presence of abnormal neurological exam, family history of epilepsy, existence of perinatal insults and electroencephalography or video-EEG with at least one ictal recording. We included 20 patients since 2010-2012. Mean age of our population was 25.9 years (9-46 years), 7 females, 13 males, they all had a negative family history of epilepsy, and only two patients had pathological neurological exam, both with mild contralateral paresis. Mean seizure onset age was 5.71 years (2 months-17 years) and the average frequency was 5.1 seizures per month (0-15). Two patients became seizure-free after adjusting antiepileptic drugs. Focal seizures were presented in the 100% of our population. The low frequency of seizure emphasizes the heterogeneity of these patients and the importance of the correct use of antiepileptic drugs schemes, as well as it can be dynamic over time. A proportion of medically resistant patients with cortical dysplasia are poor surgical candidates because the lesion cannot be completely identify or removed if it involves eloquent areas of the cortex. With the development of new drugs and the correct choice of treatment schedules is expected that more patients with focal cortical dysplasia would be treated successfully.

show abstract

Assessment and surgical outcomes for mild type I and severe type II cortical dysplasia: A critical review and the UCLA experience

Cited by 352 publications

References 127 publications

Malformations of cortical development

Malformations of cortical development

Magnetic resonance imaging abnormalities in the resection region correlate with histopathological type, gliosis extent, and postoperative outcome in pediatric cortical dysplasia

Clinical Features of a Series of Non-Surgical Patients with Focal Cortical Dysplasia and Epilepsy

Contact Info

Product

Resources

About