Clinical characteristics and epilepsy outcomes following surgery caused by focal cortical dysplasia (type IIa) in 110 adult epileptic patients

Abstract

The aim of the present study was to investigate the effects of surgical intervention of focal cortical dysplasia (FCD) IIa on the outcome of epilepsy, and to evaluate the prognostic factors of seizure freedom. Patient data from epilepsy surgeries were retrospectively reviewed at the Second Affiliated Hospital of Dalian Medical University between 2007 and 2015. A total of 110 patients with a definite pathological diagnosis of FCD IIa were included. Moreover, the clinical characteristics, seizure outcome and quality of life in adults with FCD IIa were evaluated. The Engel seizure outcome achievements were class I in 72, class II in 20, class III in 11 and class IV in 7 patients. In addition, the Engel seizure outcome was relevant with the resection range of the lesions (P=0.028). The assessments of electrocorticography (ECoG) patterns and magnetic resonance imaging (MRI) are relevant to determining the extent of the resection, which may influence the surgery outcome (P=0.001 and P=0.023). Using multivariate regression analyses, the extent of resection, seizure frequency, preoperative ECoG and location of resection were the most important risk factors for seizure recurrence. The results of quality of life in epilepsy-10 scoring revealed that the quality of life improved significantly following surgery (P<0.01). Moreover, surgical intervention, EcoG, MRI positioning and complete resection helped to have improved seizure control, relief of anxiety and quality of life. All these observations strongly recommend an early consideration of epilepsy surgery in FCD IIa patients.

Post-Surgical Outcome and Its Determining Factors in Patients Operated on With Focal Cortical Dysplasia Type II—A Retrospective Monocenter Study

“…The observation that the extent (i.e., completeness) of resection had a significant influence on post-surgical outcome is in concordance with previous publications ( 10 , 12 , 21 , 35 – 37 ).…”

“…Nevertheless, since some of these patients could not be reached any more (changing address, etc. ), and some of them did not provide a written informed consent for the phone interview, we cannot completely rule out that the slight worsening tendency—though reported in several studies ( 35 )—partially resulted from a disequilibrium of patients as described above.…”

“…Among pediatric patients, frontal or temporal FCD location was associated with a significantly better outcome compared with central or posterior locations ( 12 ). A temporal lobe location in patients with FCD IIA was also found to be a predictor for positive outcome ( 35 ). In our series, we did not find a consistent and significant difference between long-term outcomes in frontal vs. non-frontal location; on the other hand, due to the paucity of temporal lobe location, we could not examine this lobar location separately.…”

Factors Associated with Short-Term Seizure Recurrence in Extratemporal Epilepsy Surgery

“…In the current study, patients with a medical record had a less favorable Engel classification, similar to Mariani V et al [15]. Conversely, Sun et al [16] describe that 33.6 % have a positive history, most of them in the Engel I class.…”

“…Several authors, in turn, identified this factor as a predictor of good prognosis in extratemporal surgery. [4,5,16,21,[25][26][27][28][29] The use of intraoperative electrocorticography in our environment has become increasingly important to delimit the resection edges and is related to the best results of the present research. Studies with ECoG offer more excellent coverage of areas of the cortex surface and allow spatial contiguity in detecting the ictal onset and its immediate propagation, the complete resection guided by ECoG of the cortical area that presents a FCD pattern, is a predictor of an excellent postsurgical prognosis detected by Morales et al [6] in Cuba and other authors.…”