John Libbey Eurotext

Epileptic Disorders

The Educational Journal of the

Epilepsy surgery for polymicrogyria: a challenge to be undertaken Volume 20, issue 5, October 2018

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Authors
1 Centre de Recherche en Automatique de Nancy (CRAN), University of Lorraine, CNRS, UMR 7039, Vandoeuvre
2 Department of Neurology, Central University Hospital, CHU de Nancy, Nancy
3 Medical Faculty, University of Lorraine, Nancy, France
4 Departement of Neuropediatrics, University Children's Hospital, Zurich, Switzerland
* Correspondence: Georgia Ramantani Neuropediatrics, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
  • Key words: polymicrogyria, drug-resistant epilepsy, cortical malformation, stereo-electroencephalography, epilepsy surgery, seizure freedom
  • DOI : 10.1684/epd.2018.1004
  • Page(s) : 319-38
  • Published in: 2018

Polymicrogyria (PMG) is one of the most common malformations of cortical development (MCDs), with epilepsy affecting most patients. PMG-related drug-resistant epilepsy patients can be considered for epilepsy surgery in well-selected cases. In this context, a comprehensive presurgical evaluation, often including stereo-electroencephalography (SEEG), is warranted to accurately delineate the epileptogenic zone. The heterogeneity of intrinsic epileptogenicity in PMG, together with the additional or predominant involvement of remote cortical areas, calls for a different strategy in PMG compared to other MCDs, namely one that is not predominantly MRI- but rather SEEG-oriented. Favourable results in terms of seizure freedom and antiepileptic drug cessation are feasible in a large proportion of patients with unilateral PMG. PMG extent should not deter from exploring the possibility of epilepsy surgery. On the other hand, patients with hemispheric PMG can be excellent hemispherotomy candidates, particularly when presenting with contralateral hemiparesis. Recent findings support the early consideration of surgery in PMG-related drug-resistant epilepsy.