Long‐term seizure outcome in 211 patients with focal cortical dysplasia

Fauser, Susanne; Essang, Charles; Altenmüller, Dirk‐Matthias; Staack, Anke M.; Steinhoff, Bernhard J.; Strobl, Karl; Bast, Thomas; Schubert‐Bast, Susanne; Stephani, Ulrich; Wiegand, Gert; Prinz, Marco; Brandt, Armin; Zentner, Josef; Schulze‐Bonhage, Andreas

doi:10.1111/epi.12876

Cited by 160 publications

(177 citation statements)

References 39 publications

Supporting

Mentioning

128

Contrasting

Unclassified

Order By: Relevance

“…We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Susanne Fauser 1,3 suanne.fauser@uni-ulm.de Epilepsia, 56 (7):1175-1184, 2015…”

Section: Disclosurementioning

confidence: 99%

Commentary on long‐term seizure outcome in 211 patients with focal cortical dysplasia

2015

View full text Add to dashboard Cite

Commentary on long-term seizure outcome in 211 patients with focal cortical dysplasia To the Editors:We have read with great interest the paper by Fauser et al.,1 titled "Long-term seizure outcome in 211 patients with focal cortical dysplasia. "This study is a valuable effort to identify the predictors of long-term seizure control in epilepsy surgery for focal cortical dysplasia (FCD).As the authors stated, FCD represents a common architectural or cytoarchitectural cortical disorder underlying pharmacoresistant epilepsy.We agree with the authors about the importance in epilepsy surgery of both identifying the factors predicting seizure outcome and relating seizure outcome to histopathologic diagnosis. 2-9The value of this study is represented by the large number of enrolled patients and the relationship between seizure outcome and FCD types. However, it is our opinion that considering FCD independently of the site involved (left or right hemisphere, critical cerebral areas) and of the different surgical approaches (ranging from lesionectomy to multilobar lobectomy) represents a notable bias. We think that this methodology likely may have contributed to masking of some important differences among FCD types I, II, and IIIa, thereby preventing the acquisition of statistically significant differences regarding seizure freedom.In our temporal lobe epilepsy surgery experience, the most common pathology in adult patients has been FCD type IIIa. 3,7 Furthermore, according to the literature, 9,10 the patients with hippocampal sclerosis (HS) associated with FCD type I (now classified as FCD IIIa) show a seizure outcome similar to that of patients with isolated HS (84% Engel class I vs. 82%) and better than patients with isolated FCD type I (63% Engel class I). 3,7,[10][11][12] Our results indicate also that cases of associated FCD type II are not as rare as previously reported, such as for instance, the association between FCD type II and other structural abnormalities, namely, HS or epilepsy-associated tumors (EATs). These aspects may prove a useful parameter for more precise histopathologic classification that may help to clarify the relationship with seizure outcome and the implications for pathogenetic epileptogenic mechanisms.Finally, a methodologic approach utilized for other brain pathologies, such as cerebral tumor or vascular lesions, will be unavoidable due to the continuous remarkable advances in pathologic knowledge of underlying epilepsy lesions.This unifying methodologic approach aims to relate the surgical results to the precise type of pathology, the site of the lesion, and the surgical strategy utilized. We think that this approach will help epilepsy surgery to come out of a long-lasting status of indeterminateness and promote a greater spread and application of the practice. DISCLOSUREWe have no conflict of interest in publishing this letter. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

show abstract

Section: Disclosurementioning

confidence: 99%

Commentary on long‐term seizure outcome in 211 patients with focal cortical dysplasia

2015

View full text Add to dashboard Cite

show abstract

“…In this group of patients, no FCD was observed in the MRI of 19% of patients, similar to what has been reported by other authors (14%-23%). 7,14 An excellent post-operative prognosis, Engel I, was established in 52.3% of our patients.…”

Section: Discussionmentioning

confidence: 57%

Epilepsy surgery in children and adolescents: Report on 43 cases

2016

Arch Argent Pediat

View full text Add to dashboard Cite

Epilepsy surgery in children with refractory epilepsy is one of the most effective methods to control seizures. The proper selection and assessment of surgery candidates is critical for surgical treatment to be adequately effective and safe. The purpose of this article is to describe our experience with 43 consecutive pediatric patients that underwent epilepsy surgery for refractory epilepsy between September 2005 and May 2014. Effectiveness, safety, and prognostic factors were analyzed. The median age was 12 years old at the time of surgery and 4.5 years old at epilepsy onset, with a latency period of up to 6 years until surgery. Since the surgery, the 43 patients have been in follow-up for a median of 5.4 years (±2.3 years).Resective surgery was performed in 32 patients and hemispherectomy, in 11 patients. To date, 62.8% of patients remain seizure-free. A better prognosis was observed in patients who underwent surgery with a duration of epilepsy of less than two years and in patients in whom a complete resection of the epileptogenic zone was achieved.

show abstract

“…A literature review of seizure freedom following non-iMRI-guided resection of FCD yielded a range between 46% and 67%. 1,5,6,[10][11][12]16,23 Our results demonstrate that by improving rates of gross-total resection of cortical dysplasia tissue, the addition of intraoperative imaging to existing epilepsy surgery techniques results in improved rates of seizure freedom and reduces the need for reoperation. Further randomized and blinded studies should compare the utilization of iMRI to standard epilepsy surgery protocols, addressing the variables of operative time, postsurgical outcomes, and morbidity.…”

Section: Discussionmentioning

confidence: 67%

Intraoperative MRI–guided resection of focal cortical dysplasia in pediatric patients: technique and outcomes

Sacino¹,

Ho²,

Murnick

et al. 2016

PED

View full text Add to dashboard Cite

OBJECTIVE Previous meta-analysis has demonstrated that the most important factor in seizure freedom following surgery for focal cortical dysplasia (FCD) is completeness of resection. However, intraoperative detection of epileptogenic dysplastic cortical tissue remains a challenge, potentially leading to a partial resection and the need for reoperation. The objective of this study was to determine the role of intraoperative MRI (iMRI) in the intraoperative detection and localization of FCD as well as its impact on surgical decision making, completeness of resection, and seizure control outcomes. METHODS The authors retrospectively reviewed the medical records of pediatric patients who underwent iMRI-assisted resection of FCD at the Children's National Health System between January 2014 and April 2015. Data reviewed included demographics, length of surgery, details of iMRI acquisition, postoperative seizure freedom, and complications. Postsurgical seizure outcome was assessed utilizing the Engel Epilepsy Surgery Outcome Scale. RESULTS Twelve consecutive pediatric patients (8 females and 4 males) underwent iMRI-guided resection of FCD lesions. The mean age at the time of surgery was 8.8 years ± 1.6 years (range 0.7 to 18.8 years), and the mean duration of follow up was 3.5 months ± 1.0 month. The mean age at seizure onset was 2.8 years ± 1.0 year (range birth to 9.0 years). Two patients had Type 1 FCD, 5 patients had Type 2A FCD, 2 patients had Type 2B FCD, and 3 patients had FCD of undetermined classification. iMRI findings impacted intraoperative surgical decision making in 5 (42%) of the 12 patients, who then underwent further exploration of the resection cavity. At the time of the last postoperative follow-up, 11 (92%) of the 12 patients were seizure free (Engel Class I). No patients underwent reoperation following iMRI-guided surgery. CONCLUSIONS iMRI-guided resection of FCD in pediatric patients precluded the need for repeat surgery. Furthermore, it resulted in the achievement of complete resection in all the patients, leading to a high rate of postoperative seizure freedom.

show abstract

Long‐term seizure outcome in 211 patients with focal cortical dysplasia

Cited by 160 publications

References 39 publications

Commentary on long‐term seizure outcome in 211 patients with focal cortical dysplasia

Commentary on long‐term seizure outcome in 211 patients with focal cortical dysplasia

Epilepsy surgery in children and adolescents: Report on 43 cases

Intraoperative MRI–guided resection of focal cortical dysplasia in pediatric patients: technique and outcomes

Contact Info

Product

Resources

About