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01-12-2016 | Original Communication

A longitudinal study of surgical outcome of pharmacoresistant epilepsy caused by focal cortical dysplasia

Authors: Bo Jin, Jing Wang, Jian Zhou, Shuang Wang, Yuguang Guan, Shuhua Chen

Published in: Journal of Neurology | Issue 12/2016

Abstract

This study aimed to determine the long-term surgical outcome of pharmacoresistant epilepsy caused by focal cortical dysplasia (FCD) and to identify the important predictors of the favorable surgical outcome. The study retrospectively analyzed the data of pharmacoresistant epilepsy patients with histologically proven FCD in our epilepsy center from May 2010 to December 2014. It included 120 patients with a mean follow-up of 34.6 months. Survival analysis and multivariate regression with Cox proportional hazards model were used to evaluate the rate, stability, and predictors of seizure freedom. The estimated chance of seizure freedom was 73.0 % [95 % confidence intervals (CI), 65.2–80.8 %] at 1 year after surgery, 70.0 % (95 % CI, 62.2–77.8 %) at 2 years, and 65 % (95 % CI, 53.2–76.7 %) at 5 years and beyond. Most seizure recurrences (85.7 %) happened within 12 months after surgery. The incomplete resection of FCD, presence of interictal epileptiform discharges (IEDs) on 3–6 months postoperative electroencephalography (EEG), and presence of habitual acute postoperative seizure (APOS) were independent predictors of seizure recurrence. However, other factors, such as the FCD type and sleep-related epilepsy, did not significantly influence the surgical outcome. Before becoming pharmacoresistant epilepsy, 30 (25 %) patients responded to antiepileptic drugs with a seizure-free duration of more than 1 year. The surgical outcome is favorable in patients with FCD, which is comparable to that reported in developed countries. The incomplete resection of FCD, presence of IEDs on 3–6 months postoperative EEG, and presence of habitual APOS are powerful predictive factors for seizure recurrence after surgery.

Barkovich AJ, Guerrini R, Kuzniecky RI, Jackson GD, Dobyns WB (2012) A developmental and genetic classification for malformations of cortical development: update 2012. Brain 135:1348–1369CrossRefPubMedPubMedCentral

Blumcke I, Thom M, Aronica E, Armstrong DD, Vinters HV, Palmini A et al (2011) The clinicopathologic spectrum of focal cortical dysplasias: a consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission. Epilepsia 52:158–174CrossRefPubMed

Harvey AS, Cross JH, Shinnar S, Mathern GW (2008) Defining the spectrum of international practice in pediatric epilepsy surgery patients. Epilepsia 49:146–155CrossRefPubMed

Lerner JT, Salamon N, Hauptman JS, Velasco TR, Hemb M, Wu JY et al (2009) Assessment and surgical outcomes for mild type I and severe type II cortical dysplasia: a critical review and the UCLA experience. Epilepsia 50:1310–1335CrossRefPubMed

Chassoux F, Devaux B, Landre E, Turak B, Nataf F, Varlet P et al (2000) Stereoelectroencephalography in focal cortical dysplasia: a 3D approach to delineating the dysplastic cortex. Brain 123(Pt 8):1733–1751CrossRefPubMed

Kloss S, Pieper T, Pannek H, Holthausen H, Tuxhorn I (2002) Epilepsy surgery in children with focal cortical dysplasia (FCD): results of long-term seizure outcome. Neuropediatrics 33:21–26CrossRefPubMed

Tassi L, Colombo N, Garbelli R, Francione S, Lo Russo G, Mai R et al (2002) Focal cortical dysplasia: neuropathological subtypes, EEG, neuroimaging and surgical outcome. Brain 125:1719–1732CrossRefPubMed

Kral T, Clusmann H, Blumcke I, Fimmers R, Ostertun B, Kurthen M et al (2003) Outcome of epilepsy surgery in focal cortical dysplasia. J Neurol Neurosurg Psychiatry 74:183–188CrossRefPubMedPubMedCentral

Cohen-Gadol AA, Ozduman K, Bronen RA, Kim JH, Spencer DD (2004) Long-term outcome after epilepsy surgery for focal cortical dysplasia. J Neurosurg 101:55–65CrossRefPubMed

10.

Fauser S, Schulze-Bonhage A, Honegger J, Carmona H, Huppertz HJ, Pantazis G et al (2004) Focal cortical dysplasias: surgical outcome in 67 patients in relation to histological subtypes and dual pathology. Brain 127:2406–2418CrossRefPubMed

11.

Hader WJ, Mackay M, Otsubo H, Chitoku S, Weiss S, Becker L et al (2004) Cortical dysplastic lesions in children with intractable epilepsy: role of complete resection. J Neurosurg 100:110–117PubMed

12.

Hamiwka L, Jayakar P, Resnick T, Morrison G, Ragheb J, Dean P, Dunoyer C, Duchowny M (2005) Surgery for epilepsy due to cortical malformations: ten-year follow-up. Epilepsia 46:556–560CrossRefPubMed

13.

Widdess-Walsh P, Kellinghaus C, Jeha L, Kotagal P, Prayson R, Bingaman W et al (2005) Electro-clinical and imaging characteristics of focal cortical dysplasia: correlation with pathological subtypes. Epilepsy Res 67:25–33CrossRefPubMed

14.

Alexandre V Jr, Walz R, Bianchin MM, Velasco TR, Terra-Bustamante VC, Wichert-Ana L et al (2006) Seizure outcome after surgery for epilepsy due to focal cortical dysplastic lesions. Seizure 15:420–427CrossRefPubMed

15.

Park CK, Kim SK, Wang KC, Hwang YS, Kim KJ, Chae JH et al (2006) Surgical outcome and prognostic factors of pediatric epilepsy caused by cortical dysplasia. Childs Nerv Syst 22:586–592CrossRefPubMed

16.

Siegel AM, Cascino GD, Meyer FB, Marsh WR, Scheithauer BW, Sharbrough FW (2006) Surgical outcome and predictive factors in adult patients with intractable epilepsy and focal cortical dysplasia. Acta Neurol Scand 113:65–71CrossRefPubMed

17.

Kral T, von Lehe M, Podlogar M, Clusmann H, Süssmann P, Kurthen M et al (2007) Focal cortical dysplasia: long term seizure outcome after surgical treatment. J Neurol Neurosurg Psychiatry 78:853–856CrossRefPubMedPubMedCentral

18.

Kim DW, Lee SK, Chu K, Park KI, Lee SY, Lee CH et al (2009) Predictors of surgical outcome and pathologic considerations in focal cortical dysplasia. Neurology 72:211–216CrossRefPubMed

19.

Krsek P, Maton B, Jayakar P, Dean P, Korman B, Rey G et al (2009) Incomplete resection of focal cortical dysplasia is the main predictor of poor postsurgical outcome. Neurology 72:217–223CrossRefPubMed

20.

Chang EF, Wang DD, Barkovich AJ, Tihan T, Auguste KI, Sullivan JE et al (2011) Predictors of seizure freedom after surgery for malformations of cortical development. Ann Neurol 70:151–162CrossRefPubMed

21.

Fauser S, Essang C, Altenmuller DM, Staack AM, Steinhoff BJ, Strobl K et al (2015) Long-term seizure outcome in 211 patients with focal cortical dysplasia. Epilepsia 56:66–76CrossRefPubMed

22.

Mrelashvili A, Witte RJ, Wirrell EC, Nickels KC, Wong-Kisiel LC (2015) Seizure freedom in children with pathology-confirmed focal cortical dysplasia. Pediatr Neurol 53:513–518CrossRefPubMed

23.

Xue H, Cai L, Dong S, Li Y (2016) Clinical characteristics and post-surgical outcomes of focal cortical dysplasia subtypes. J Clin Neurosci 23:68–72CrossRefPubMed

24.

Fauser S, Bast T, Altenmuller DM, Schulte-Monting J, Strobl K, Steinhoff BJ et al (2008) Factors influencing surgical outcome in patients with focal cortical dysplasia. J Neurol Neurosurg Psychiatry 79:103–105CrossRefPubMed

25.

Oluigbo CO, Wang J, Whitehead MT, Magge S, Myseros JS, Yaun A et al (2015) The influence of lesion volume, perilesion resection volume, and completeness of resection on seizure outcome after resective epilepsy surgery for cortical dysplasia in children. J Neurosurg Pediatr 15:644–650CrossRefPubMed

26.

Rowland NC, Englot DJ, Cage TA, Sughrue ME, Barbaro NM, Chang EF (2012) A meta-analysis of predictors of seizure freedom in the surgical management of focal cortical dysplasia. J Neurosurg 116:1035–1041CrossRefPubMed

27.

Nobili L, Francione S, Mai R, Cardinale F, Castana L, Tassi L et al (2007) Surgical treatment of drug-resistant nocturnal frontal lobe epilepsy. Brain 130:561–573CrossRefPubMed

28.

Beghi E, Carpio A, Forsgren L, Hesdorffer DC, Malmgren K, Sander JW et al (2010) Recommendation for a definition of acute symptomatic seizure. Epilepsia 51:671–675CrossRefPubMed

29.

Engel JJ, Van Ness P, Rasmussen T et al (1993) Outcome with respect to epileptic seizures, 2nd edn. Raven Press, New York

30.

Jeha LE, Najm IM, Bingaman WE, Khandwala F, Widdess-Walsh P, Morris HH et al (2006) Predictors of outcome after temporal lobectomy for the treatment of intractable epilepsy. Neurology 66:1938–1940CrossRefPubMed

31.

Jeha LE, Najm I, Bingaman W, Dinner D, Widdess-Walsh P, Luders H (2007) Surgical outcome and prognostic factors of frontal lobe epilepsy surgery. Brain 130:574–584CrossRefPubMed

32.

Jehi LE, O’Dwyer R, Najm I, Alexopoulos A, Bingaman W (2009) A longitudinal study of surgical outcome and its determinants following posterior cortex epilepsy surgery. Epilepsia 50:2040–2052CrossRefPubMed

33.

Spencer SS (2002) Neural networks in human epilepsy: evidence of and implications for treatment. Epilepsia 43:219–227CrossRefPubMed

34.

Simasathien T, Vadera S, Najm I, Gupta A, Bingaman W, Jehi L (2013) Improved outcomes with earlier surgery for intractable frontal lobe epilepsy. Ann Neurol 73:646–654CrossRefPubMed

35.

Malla BR, O’Brien TJ, Cascino GD, So EL, Radhakrishnan K, Silbert P et al (1998) Acute postoperative seizures following anterior temporal lobectomy for intractable partial epilepsy. J Neurosurg 89:177–182CrossRefPubMed

36.

Boonyapisit K, Najm I, Klem G, Ying Z, Burrier C, LaPresto E et al (2003) Epileptogenicity of focal malformations due to abnormal cortical development: direct electrocorticographic-histopathologic correlations. Epilepsia 44:69–76CrossRefPubMed

37.

Marusic P, Najm IM, Ying Z, Prayson R, Rona S, Nair D et al (2002) Focal cortical dysplasias in eloquent cortex: functional characteristics and correlation with MRI and histopathologic changes. Epilepsia 43:27–32CrossRefPubMed

38.

Wagner J, Urbach H, Niehusmann P, von Lehe M, Elger CE, Wellmer J (2011) Focal cortical dysplasia type IIb: completeness of cortical, not subcortical, resection is necessary for seizure freedom. Epilepsia 52:1418–1424CrossRefPubMed

39.

Najm I, Jehi L, Palmini A, Gonzalez-Martinez J, Paglioli E, Bingaman W (2013) Temporal patterns and mechanisms of epilepsy surgery failure. Epilepsia 54:772–782CrossRefPubMed

40.

Guerrini R, Duchowny M, Jayakar P, Krsek P, Kahane P, Tassi L et al (2015) Diagnostic methods and treatment options for focal cortical dysplasia. Epilepsia 56:1669–1686CrossRefPubMed

41.

Losurdo A, Proserpio P, Cardinale F, Gozzo F, Tassi L, Mai R et al (2014) Drug-resistant focal sleep related epilepsy: results and predictors of surgical outcome. Epilepsy Res 108:953–962CrossRefPubMed

42.

Harvey AS, Mandelstam SA, Maixner WJ, Leventer RJ, Semmelroch M, MacGregor D et al (2015) The surgically remediable syndrome of epilepsy associated with bottom-of-sulcus dysplasia. Neurology 84:2021–2028CrossRefPubMedPubMedCentral

43.

Fauser S, Huppertz HJ, Bast T, Strobl K, Pantazis G, Altenmueller DM et al (2006) Clinical characteristics in focal cortical dysplasia: a retrospective evaluation in a series of 120 patients. Brain 129:1907–1916CrossRefPubMed

44.

Radhakrishnan A, Menon R, Menon D, Singh A, Radhakrishnan N, Vilanilam G et al (2016) Early resective surgery causes favorable seizure outcome in malformations of cortical development. Epilepsy Res 124:1–11CrossRefPubMed

Title: A longitudinal study of surgical outcome of pharmacoresistant epilepsy caused by focal cortical dysplasia
Authors: Bo Jin
Jing Wang
Jian Zhou
Shuang Wang
Yuguang Guan
Shuhua Chen
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: Journal of Neurology / Issue 12/2016
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-016-8274-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A longitudinal study of surgical outcome of pharmacoresistant epilepsy caused by focal cortical dysplasia

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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