Focal neuronal migration disorders and intractable partial epilepsy: Results of surgical treatment

Abstract

Twenty-six patients with focal or lateralized neuronal migration disorders and intractable partial epilepsy were treated surgically. Twenty-four had reliable follow-up ranging from 1 to 15 years (mean, 5.0). Pathologically, they fell into two categories: focal cortical dysplasia (12 patients) and forme fruste of tuberous sclerosis (8 patients). In the remaining 4 patients, the material was inadequate for histological analysis. Outcome regarding seizure control was assessed according to a classification most sensitive to variations in frequency of major attacks. Ten (42%) of the 24 patients achieved good or excellent outcome, 6 (25%) had a worthwhile decrease in seizure frequency, and 8 (33%) had only discrete improvement. The variable most strongly correlated with surgical outcome was the amount of lesion removed. Seventy-seven percent of patients in whom a complete excision or excision of 50% or more of the lesion was accomplished achieved excellent or good surgical outcome. Conversely, no patient with less than 50% of the lesion removed attained the same result. There was no correlation between other clinical, radiological, or electrographic variables and outcome regarding seizure control. Specifically there was no significant correlation between the amount of excision of the epileptogenic area as judged by scalp electroencephalography and electrocorticography studies, and surgical outcome. In patients with neuronal migration disorders and intractable partial epilepsy, removal of the structural abnormality takes precedence over removal of epileptogenic tissue as the main surgical strategy to achieve seizure control.

Clinical Spectrum, Seizure Outcomes, Correlation of Neuroradiology and Neuropathology, in Surgically Treated Epileptic Patients

“…[2] Bu grup için epilepsi cerrahisi yaşam sürelerini ve yaşam kalitesini artıran, sağlık harcamalarını ise azaltan bir tedavi metodu olup, parsiyel epilepsisi olan seçilmiş hastalarda etkili ve güvenli bir tedavi şeklidir. [3][4] Meziyal TLE ve lezyonel epilepsili hastalar iyi cerrahi adaylarıdır. [9] Epilepsi cerrahisinin başarı oranları epileptojenik odağı be- Literatürde de epilepsi cerrahisi adayı olan hastalarda benzer bir araştırma şeması önerilmektedir.…”

“…[1] İlaca dirençli epilepsi olarak kabul edilen bu hastaların birçoğu temporal lob epilepsisi (TLE) olup, bu hastaların bir kısmı cerrahi tedaviden fayda görmektedirler. [2,3] Epilepsi cerrahisi parsiyel epilepsisi olan belli hastalarda etkili ve güvenli bir tedavi şeklidir. [4] Literatürde TLE'si olup, epileptojenik odağı belirlenme sonrası ameliyat olanlarda nöbetsizlik oranlarının %60-80 arası değiştiği bildirilmiştir.…”

Focal cortical dysplasia: a review of pathological features, genetics, and surgical outcome

“…Seven of the 12 patients had complete cessation or excellent control of seizures after surgery. 39 Seizure control was highly correlated with successful resection of the entire lesion or at least the majority of the abnormal tissue. Complete resection did not necessarily predict cessation of seizures, however, as poor control of seizures remained in some patients despite removal of all of the tissue associated with epileptiform discharges in EEG or electrocorticography findings.…”

Temporal lobe epilepsy in childhood: review article

“…Focal cortical dysplasia was originally described in the temporal lobe (27) and is considered by some authors as the most frequent cause of refractory TLE in children (7,28,29) . It is now known that the temporal lobe is not its preferential location (30) . Neuropathological findings indicative of cortical dysplasias were present in 21 of 33 (64%) surgical specimens from children with refractory TLE (31) .…”