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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2003 Feb;74(2):183–188. doi: 10.1136/jnnp.74.2.183

Outcome of epilepsy surgery in focal cortical dysplasia

T Kral 1, H Clusmann 1, I Blumcke 1, R Fimmers 1, B Ostertun 1, M Kurthen 1, J Schramm 1
PMCID: PMC1738295  PMID: 12531945

Abstract

Objective: To describe the outcome of surgery in patients with drug resistant epilepsy and a histopathological diagnosis of focal cortical dysplasia.

Methods and subjects: Analysis of histories and presurgical and follow up data was carried out in 53 patients with a histological diagnosis of focal cortical dysplasia. Their mean age was 24.0 years (range 5 to 46), and they included 14 children and adolescents. Mean age at seizure onset was 12.4 years (0.4 to 36) and mean seizure duration was 11.6 years (1 to 45).

Results: The presurgical detection rate of focal cortical dysplasia with magnetic resonance imaging (MRI) was 96%. There were 24 temporal and 29 extratemporal resections; additional multiple subpial transections were done in 12 cases to prevent spread of seizure discharges. There was a 6% rate of complications with permanent neurological deficit, but no deaths. All resected specimens were classified by neuropathological criteria as focal cortical dysplasia. Balloon cells were seen in most cases of extratemporal focal cortical dysplasia. After a mean follow up of 50 months, 38 patients (72%) were seizure-free, two (4%) had less than two seizures a year, nine (17%) had a reduction of seizure frequency of more than 75%, and four (8%) had no improvement. Seizure outcome was similar after temporal and extratemporal surgery. The patients in need of multilobar surgery had the poorest outcome.

Conclusions: Circumscribed lesionectomy of focal dysplastic lesions provides seizure relief in patients with chronic drug resistant temporal and extratemporal epilepsy. There was a trend for the best seizure outcome to be in patients with early presurgical evaluation and early surgery, and in whom lesions were identified on the preoperative MRI studies.

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Selected References

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  1. Armon C., Radtke R. A., Friedman A. H., Dawson D. V. Predictors of outcome of epilepsy surgery: multivariate analysis with validation. Epilepsia. 1996 Sep;37(9):814–821. doi: 10.1111/j.1528-1157.1996.tb00033.x. [DOI] [PubMed] [Google Scholar]
  2. Barkovich A. J., Kuzniecky R. I., Jackson G. D., Guerrini R., Dobyns W. B. Classification system for malformations of cortical development: update 2001. Neurology. 2001 Dec 26;57(12):2168–2178. doi: 10.1212/wnl.57.12.2168. [DOI] [PubMed] [Google Scholar]
  3. Becker L. E. Central neuronal tumors in childhood: relationship to dysplasia. J Neurooncol. 1995;24(1):13–19. doi: 10.1007/BF01052652. [DOI] [PubMed] [Google Scholar]
  4. Chevassus-au-Louis N., Baraban S. C., Gaïarsa J. L., Ben-Ari Y. Cortical malformations and epilepsy: new insights from animal models. Epilepsia. 1999 Jul;40(7):811–821. doi: 10.1111/j.1528-1157.1999.tb00786.x. [DOI] [PubMed] [Google Scholar]
  5. Cotter D., Honavar M., Lovestone S., Raymond L., Kerwin R., Anderton B., Everall I. Disturbance of Notch-1 and Wnt signalling proteins in neuroglial balloon cells and abnormal large neurons in focal cortical dysplasia in human cortex. Acta Neuropathol. 1999 Nov;98(5):465–472. doi: 10.1007/s004010051111. [DOI] [PubMed] [Google Scholar]
  6. Crino P. B., Eberwine J. Cellular and molecular basis of cerebral dysgenesis. J Neurosci Res. 1997 Dec 15;50(6):907–916. doi: 10.1002/(SICI)1097-4547(19971215)50:6<907::AID-JNR1>3.0.CO;2-H. [DOI] [PubMed] [Google Scholar]
  7. Eriksson S., Malmgren K., Rydenhag B., Jönsson L., Uvebrant P., Nordborg C. Surgical treatment of epilepsy--clinical, radiological and histopathological findings in 139 children and adults. Acta Neurol Scand. 1999 Jan;99(1):8–15. doi: 10.1111/j.1600-0404.1999.tb00652.x. [DOI] [PubMed] [Google Scholar]
  8. Helmstaedter C., Elger C. E. Functional plasticity after left anterior temporal lobectomy: reconstitution and compensation of verbal memory functions. Epilepsia. 1998 Apr;39(4):399–406. doi: 10.1111/j.1528-1157.1998.tb01392.x. [DOI] [PubMed] [Google Scholar]
  9. Hirabayashi S., Binnie C. D., Janota I., Polkey C. E. Surgical treatment of epilepsy due to cortical dysplasia: clinical and EEG findings. J Neurol Neurosurg Psychiatry. 1993 Jul;56(7):765–770. doi: 10.1136/jnnp.56.7.765. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Jeong S. W., Lee S. K., Kim K. K., Kim H., Kim J. Y., Chung C. K. Prognostic factors in anterior temporal lobe resections for mesial temporal lobe epilepsy: multivariate analysis. Epilepsia. 1999 Dec;40(12):1735–1739. doi: 10.1111/j.1528-1157.1999.tb01591.x. [DOI] [PubMed] [Google Scholar]
  11. Kasper B. S., Stefan H., Buchfelder M., Paulus W. Temporal lobe microdysgenesis in epilepsy versus control brains. J Neuropathol Exp Neurol. 1999 Jan;58(1):22–28. doi: 10.1097/00005072-199901000-00003. [DOI] [PubMed] [Google Scholar]
  12. Kral T., Kuczaty S., Blümcke I., Urbach H., Clusmann H., Wiestler O. D., Elger C., Schramm J. Postsurgical outcome of children and adolescents with medically refractory frontal lobe epilepsies. Childs Nerv Syst. 2001 Oct;17(10):595–601. doi: 10.1007/s003810100497. [DOI] [PubMed] [Google Scholar]
  13. Kurthen M., Helmstaedter C., Linke D. B., Hufnagel A., Elger C. E., Schramm J. Quantitative and qualitative evaluation of patterns of cerebral language dominance. An amobarbital study. Brain Lang. 1994 May;46(4):536–564. doi: 10.1006/brln.1994.1030. [DOI] [PubMed] [Google Scholar]
  14. Leventer R. J., Phelan E. M., Coleman L. T., Kean M. J., Jackson G. D., Harvey A. S. Clinical and imaging features of cortical malformations in childhood. Neurology. 1999 Sep 11;53(4):715–722. doi: 10.1212/wnl.53.4.715. [DOI] [PubMed] [Google Scholar]
  15. Lévesque M. F., Nakasato N., Vinters H. V., Babb T. L. Surgical treatment of limbic epilepsy associated with extrahippocampal lesions: the problem of dual pathology. J Neurosurg. 1991 Sep;75(3):364–370. doi: 10.3171/jns.1991.75.3.0364. [DOI] [PubMed] [Google Scholar]
  16. Morrell F., Whisler W. W., Bleck T. P. Multiple subpial transection: a new approach to the surgical treatment of focal epilepsy. J Neurosurg. 1989 Feb;70(2):231–239. doi: 10.3171/jns.1989.70.2.0231. [DOI] [PubMed] [Google Scholar]
  17. Orbach D., Romanelli P., Devinsky O., Doyle W. Late seizure recurrence after multiple subpial transections. Epilepsia. 2001 Oct;42(10):1316–1319. doi: 10.1111/j.1528-1167.2001.45300.x. [DOI] [PubMed] [Google Scholar]
  18. Palmini A., Andermann F., Olivier A., Tampieri D., Robitaille Y., Andermann E., Wright G. Focal neuronal migration disorders and intractable partial epilepsy: a study of 30 patients. Ann Neurol. 1991 Dec;30(6):741–749. doi: 10.1002/ana.410300602. [DOI] [PubMed] [Google Scholar]
  19. Palmini A., Gambardella A., Andermann F., Dubeau F., da Costa J. C., Olivier A., Tampieri D., Gloor P., Quesney F., Andermann E. Intrinsic epileptogenicity of human dysplastic cortex as suggested by corticography and surgical results. Ann Neurol. 1995 Apr;37(4):476–487. doi: 10.1002/ana.410370410. [DOI] [PubMed] [Google Scholar]
  20. Prayson R. A., Estes M. L. Cortical dysplasia: a histopathologic study of 52 cases of partial lobectomy in patients with epilepsy. Hum Pathol. 1995 May;26(5):493–500. doi: 10.1016/0046-8177(95)90244-9. [DOI] [PubMed] [Google Scholar]
  21. Raymond A. A., Fish D. R., Sisodiya S. M., Alsanjari N., Stevens J. M., Shorvon S. D. Abnormalities of gyration, heterotopias, tuberous sclerosis, focal cortical dysplasia, microdysgenesis, dysembryoplastic neuroepithelial tumour and dysgenesis of the archicortex in epilepsy. Clinical, EEG and neuroimaging features in 100 adult patients. Brain. 1995 Jun;118(Pt 3):629–660. doi: 10.1093/brain/118.3.629. [DOI] [PubMed] [Google Scholar]
  22. Raymond A. A., Fish D. R., Stevens J. M., Cook M. J., Sisodiya S. M., Shorvon S. D. Association of hippocampal sclerosis with cortical dysgenesis in patients with epilepsy. Neurology. 1994 Oct;44(10):1841–1845. doi: 10.1212/wnl.44.10.1841. [DOI] [PubMed] [Google Scholar]
  23. Roach E. S., Smith M., Huttenlocher P., Bhat M., Alcorn D., Hawley L. Diagnostic criteria: tuberous sclerosis complex. Report of the Diagnostic Criteria Committee of the National Tuberous Sclerosis Association. J Child Neurol. 1992 Apr;7(2):221–224. doi: 10.1177/088307389200700219. [DOI] [PubMed] [Google Scholar]
  24. Rojiani A. M., Emery J. A., Anderson K. J., Massey J. K. Distribution of heterotopic neurons in normal hemispheric white matter: a morphometric analysis. J Neuropathol Exp Neurol. 1996 Feb;55(2):178–183. doi: 10.1097/00005072-199602000-00006. [DOI] [PubMed] [Google Scholar]
  25. Sawhney I. M., Robertson I. J., Polkey C. E., Binnie C. D., Elwes R. D. Multiple subpial transection: a review of 21 cases. J Neurol Neurosurg Psychiatry. 1995 Mar;58(3):344–349. doi: 10.1136/jnnp.58.3.344. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Schramm J., Kral T., Clusmann H. Transsylvian keyhole functional hemispherectomy. Neurosurgery. 2001 Oct;49(4):891–901. doi: 10.1097/00006123-200110000-00021. [DOI] [PubMed] [Google Scholar]
  27. Sisodiya S. M., Free S. L., Stevens J. M., Fish D. R., Shorvon S. D. Widespread cerebral structural changes in patients with cortical dysgenesis and epilepsy. Brain. 1995 Aug;118(Pt 4):1039–1050. doi: 10.1093/brain/118.4.1039. [DOI] [PubMed] [Google Scholar]
  28. Sisodiya S. M. Surgery for malformations of cortical development causing epilepsy. Brain. 2000 Jun;123(Pt 6):1075–1091. doi: 10.1093/brain/123.6.1075. [DOI] [PubMed] [Google Scholar]
  29. Smith M. C. Multiple subpial transection in patients with extratemporal epilepsy. Epilepsia. 1998;39 (Suppl 4):S81–S89. doi: 10.1111/j.1528-1157.1998.tb05128.x. [DOI] [PubMed] [Google Scholar]
  30. Taylor D. C., Falconer M. A., Bruton C. J., Corsellis J. A. Focal dysplasia of the cerebral cortex in epilepsy. J Neurol Neurosurg Psychiatry. 1971 Aug;34(4):369–387. doi: 10.1136/jnnp.34.4.369. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Urbach Horst, Scheffler Björn, Heinrichsmeier Thomas, von Oertzen Joachim, Kral Thomas, Wellmer Joerg, Schramm Johannes, Wiestler Otmar D., Blümcke Ingmar. Focal cortical dysplasia of Taylor's balloon cell type: a clinicopathological entity with characteristic neuroimaging and histopathological features, and favorable postsurgical outcome. Epilepsia. 2002 Jan;43(1):33–40. doi: 10.1046/j.1528-1157.2002.38201.x. [DOI] [PubMed] [Google Scholar]
  32. Wolf H. K., Wiestler O. D. Surgical pathology of chronic epileptic seizure disorders. Brain Pathol. 1993 Oct;3(4):371–380. doi: 10.1111/j.1750-3639.1993.tb00765.x. [DOI] [PubMed] [Google Scholar]
  33. Wyler A. R., Wilkus R. J., Rostad S. W., Vossler D. G. Multiple subpial transections for partial seizures in sensorimotor cortex. Neurosurgery. 1995 Dec;37(6):1122–1128. doi: 10.1227/00006123-199512000-00012. [DOI] [PubMed] [Google Scholar]
  34. Wyllie E., Comair Y. G., Kotagal P., Bulacio J., Bingaman W., Ruggieri P. Seizure outcome after epilepsy surgery in children and adolescents. Ann Neurol. 1998 Nov;44(5):740–748. doi: 10.1002/ana.410440507. [DOI] [PubMed] [Google Scholar]
  35. Zentner J., Hufnagel A., Wolf H. K., Ostertun B., Behrens E., Campos M. G., Elger C. E., Wiestler O. D., Schramm J. Surgical treatment of neoplasms associated with medically intractable epilepsy. Neurosurgery. 1997 Aug;41(2):378–387. doi: 10.1097/00006123-199708000-00008. [DOI] [PubMed] [Google Scholar]

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