Clinical Features of a Series of Non-Surgical Patients with Focal Cortical Dysplasia and Epilepsy
American Journal of Psychiatry and Neuroscience
Volume 2, Issue 1, January 2014, Pages: 8-12
Received: Jan. 6, 2014;
Published: Jan. 30, 2014
Views 3194 Downloads 152
Gustavo Seifer, Center for Clinical and Experimental Neuroscience, Epilepsy, Cognition and Behavior, IBCN, School of Medicine, Epilepsy Section, Division of Neurology, Ramos Mejía Hospital, UBA, CONICET. Buenos Aires, Argentina
Juan Pablo Princich, Center for Clinical and Experimental Neuroscience, Epilepsy, Cognition and Behavior, IBCN, School of Medicine, Epilepsy Section, Division of Neurology, Ramos Mejía Hospital, UBA, CONICET. Buenos Aires, Argentina
Silvia Kochen, Center for Clinical and Experimental Neuroscience, Epilepsy, Cognition and Behavior, IBCN, School of Medicine, Epilepsy Section, Division of Neurology, Ramos Mejía Hospital, UBA, CONICET. Buenos Aires, Argentina
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.
Juan Pablo Princich,
Clinical Features of a Series of Non-Surgical Patients with Focal Cortical Dysplasia and Epilepsy, American Journal of Psychiatry and Neuroscience.
Vol. 2, No. 1,
2014, pp. 8-12.
Marin-Padilla M. Developmental neuropathology and impact of perinatal brain damage. III: gray matter lesions of the neocortex. J Neuropathol Exp Neurol. 1999; 58: 407-29.
Krsek P, Pieper T, Karlmeier A, Hildebrandt M, Kolodziejczyk D, Winkler P. et al. Different presurgical characteristics and seizure outcomes in children with focal cortical dysplasia type I or II. Epilepsia. 2009; 50:125-37.
Chung CK, Lee SK, Kim KJ. Surgical outcome of epilepsy caused by cortical dysplasia. Epilepsia. 2005; 46 Suppl 1:25-9.
Semah F, Picot MC, Adam C, Broglin D, Arzimanoglou A, Bazin B, et al. Is the underlying cause of epilepsy a major prognostic factor for recurrence? Neurology. 1998; 51: 1256-62.
Brodtkorb E, Nilsen G, Smevik O, Rinck PA. Epilepsy and anomalies of neuronal migration: MRI and clinical aspects. Acta Neurol Scand. 1992; 86:24-32.
Steffenburg U, Hedstrom A, Lindroth A, Wiklund LM, Hagberg G, Kyllerman M. Intractable epilepsy in a population-based series of mentally retarded children. Epilepsia. 1998; 39:767-75.
Taylor DC, Falconer MA, Bruton CJ, Corsellis JA. Focal dysplasia of the cerebral cortex in epilepsy. J Neurol Neurosurg Psychiatry. 1971; 34:369-87.
Ward LC, Bergman MA, Hebert KR. WAIS-IV subtest covariance structure: conceptual and statistical considerations. Psychol Assess. 2012. 24:328-40.
Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde Boas W, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia. 2010; 51:676-85.
Barkovich AJ. Malformations of neocortical development: magnetic resonance imaging correlates. Curr Opin Neurol. 1996; 9:118-21.
Barkovich AJ, Kuzniecky RI. Neuroimaging of focal malformations of cortical development. J Clin Neurophysiol. 1996; 13:481-94.
Barkovich AJ, Kuzniecky RI, Dobyns WB. Radiologic classification of malformations of cortical development. Curr Opin Neurol. 2001; 14:145-9.
Blumcke I, Thom M, Aronica E, Armstrong DD, Vinters HV, Palmini A, et al. The clinicopathologic spectrum of focal cortical dysplasias: a consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission. Epilepsia. 2011; 52:158-74.
Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010; 51: 1069-77.
Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Chadwick D, Guerreiro C, et al. ILAE treatment guidelines: evidence-based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2006; 47:1094-120.
Lerner JT, Salamon N, Hauptman JS, Velasco TR, Hemb M, Wu JY, et al. Assessment and surgical outcomes for mild type I and severe type II cortical dysplasia: a critical review and the UCLA experience. Epilepsia. 2009; 50: 1310-35.
Hauptman JS, Mathern GW. Surgical treatment of epilepsy associated with cortical dysplasia: 2012 update. Epilepsia. 2012; 53 Suppl 4:98-104.
Papayannis CE, Consalvo D, Kauffman MA, Seifer G, Oddo S, D'Alessio L, et al. Malformations of cortical development and epilepsy in adult patients. Seizure. 2012; 21: 377-84.
Noachtar S, Bilgin O, Remi J, Chang N, Midi I, Vollmar C, et al. Interictal regional polyspikes in noninvasive EEG suggest cortical dysplasia as etiology of focal epilepsies. Epilepsia. 2008; 49:1011-7.
Seifer G, Blenkmann A, Princich JP, Consalvo D, Papayannis C, Muravchik C, et al. Noninvasive approach to focal cortical dysplasias: clinical, EEG, and neuroimaging features. Epilepsy Res Treat. 2012;736784.
Blenkmann A, Seifer G, Princich JP, Consalvo D, Kochen S, Muravchik C. Association between equivalent current dipole source localization and focal cortical dysplasia in epilepsy patients. Epilepsy Res. 2012; 98:223-31.
Mathern GW, Giza CC, Yudovin S, Vinters HV, Peacock WJ, Shewmon DA, et al. Postoperative seizure control and antiepileptic drug use in pediatric epilepsy surgery patients: the UCLA experience, 1986-1997. Epilepsia. 1999; 40: 1740-9.
Varotto G, Tassi L, Franceschetti S, Spreafico R, Panzica F. Epileptogenic networks of type II focal cortical dysplasia: a stereo-EEG study. Neuroimage. 2012; 61:591-8.
Sisodiya SM. Surgery for malformations of cortical development causing epilepsy. Brain. 2000; 123:1075-91.
Tassi L, Colombo N, Garbelli R, Francione S, Lo Russo G, Mai R, et al. Focal cortical dysplasia: neuropathological subtypes, EEG, neuroimaging and surgical outcome. Brain. 2002; 125:1719-32.
Colombo N, Tassi L, Galli C, Citterio A, Lo Russo G, Scialfa G, et al. Focal cortical dysplasias: MR imaging, histopathologic, and clinical correlations in surgically treated patients with epilepsy. AJNR Am J Neuroradiol. 2003; 24:724-33.
Nakken KO, Server A, Eriksson AS, Kostov H, Lossius R, Haakonsen M. A patient with a 44-year history of epilepsia partialis continua caused by a perirolandic cortical dysplasia. Epilepsy Behav. 2005; 6:94-7.
Nakken KO, Eriksson AS, Kostov H, Lossius R, Haakonsen M, Server A, et al. [Epilepsia partialis continua (Kojevnikov's syndrome)]. Tidsskr Nor Laegeforen. 2005; 125:746-9.
Tan RY, Neligan A, Shorvon SD. The uncommon causes of status epilepticus: a systematic review. Epilepsy Res. 2010; 91:111-22.