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Epileptic Disorders

The Educational Journal of the International League Against Epilepsy

Type I focal cortical dysplasia: surgical outcome is related to histopathology Volume 12, numéro 3, September 2010

Auteurs
C. Munari Epilepsy Surgery Centre, Division of Epilepsy Clinic and Experimental Neurophysiology, C. Besta Neurological Institute IRCCS Foundation, Milan, Department of Neuroradiology, C. Besta Neurological Institute IRCCS Foundation, Milan, Department of Pathology, Niguarda Hospital, C. Besta Neurological Institute IRCCS Foundation, Milan, Italy
  • Mots-clés : epilepsy surgery, neuropathology, cortical dysplasia
  • DOI : 10.1684/epd.2010.0327
  • Page(s) : 181-91
  • Année de parution : 2010

Pre-surgical and post-surgical data were examined and compared from 215 consecutive patients undergoing surgery for intractable epilepsy. Patients were selected on the basis of a proven histopathological diagnosis of type I focal cortical dysplasia (FCD I), alone or associated with other lesions. The patients were divided into five sub-groups: i) 66 with isolated FCD I, ii) 76 with FCD I and hippocampal sclerosis, iii) 49 with FCD I and tumours, iv) 16 with FCD I and other malformations of cortical development and v) eight with FCD I and anoxic-ischaemic or inflammatory diseases. The duration of epilepsy was greatest in patients with FCD I associated with hippocampal sclerosis, and those with isolated FCD I showed the highest seizure frequency at the time of surgery. Hippocampal sclerosis and tumours were the most frequent pathological lesions associated with FCD I in temporal lobe epilepsy. Febrile seizures significantly correlated with the presence of hippocampal sclerosis and FCD I. Isolated FCD I was observed in 31% of the patients, characterized by frequent seizures, negative magnetic resonance imaging, and frequent frontal or multilobar involvement. In comparison to patients with FCD I associated with hippocampal sclerosis, MCD or tumours, the patients with isolated FCD I had a worse post-surgical outcome (46% in class I). Our findings indicate that there is a high incidence of FCD I associated with other apparently distinct pathologies, particularly those affecting the temporal lobe, and highlight the need for a comprehensive clinicopathological approach for the classification of FCD I.