gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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Surgical treatment of 118 children with medically intractable epilepsy due to focal cortical dysplasia

Fokale kortikale Dysplasien bei 118 Kindern mit medikamentös therapieresistenter Epilepsie

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  • corresponding author H.W. Pannek - Epilepsiezentrum Bethel, Klinikum Mara I, Evangelisches Krankenhaus Bielefeld
  • R. J. Lüttmann - Neurochirurgische Klinik Bethel, Klinikum Gilead I/II, Evangelisches Krankenhaus Bielefeld
  • T. Polster - Epilepsiezentrum Bethel, Klinikum Mara I, Evangelisches Krankenhaus Bielefeld
  • I. Tuxhorn - Epilepsiezentrum Bethel, Klinikum Mara I, Evangelisches Krankenhaus Bielefeld
  • F. Oppel - Neurochirurgische Klinik Bethel, Klinikum Gilead I/II, Evangelisches Krankenhaus Bielefeld

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.06.07

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc081.shtml

Published: May 30, 2008

© 2008 Pannek et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Focal cortical dysplasias (FCD) of Type Ia or Ib in the classification of Palmini and Lüders represent a problematic entity in paediatric epilepsy surgery. The lesion or its extent is often difficult to identify on MRI scans. The field of seizure onset in scalp video EEG monitoring frequently appears broad or multifocal. Intraoperative distinction between the lesion and normal brain is harder than in other kind of epilepsy surgery. Postoperative MRI scans again often fail to identify incompletely resected areas. We present a prospective study of paedriatic FCD patients evaluated and operated during the last 17 years.

Methods: All paediatric patients operated in the Epilepsy Center Bethel, Bielefeld, Germany with resection of a FCD between 1990 and 2007 were included in the study with analysis of time, localisation and extent of surgical resection and clinical outcome. Outcome was analysed according to Engel’s classification (I-IV) one and two years after surgery for three periods of time: A 1990 – 1995, B 1996 – 2001, C 2002 – 2007.

Results: Between December 1990 and November 2007 546 resectional operations have been performed in children and juveniles in the Epilepsy Center Bethel, Bielefeld, Germany. 127 operations were performed in 118 individuals (age on operation 9 months – 17 years, median 4,9 years; age on onset of seizures 1 day – 7 years, median 7 months) with histopathologically confirmed FCD, namely corticotomies, single lobectomies, multiple lobe resections, hemispherotomies, functional hemispherectomies and dorsal disconnections. The lesions were located in the frontal lobe in 45 patients, temporal lobe (14), parietal lobe (6), occipital lobe (4), multiples lobes (43), or in one whole hemisphere (6). In period A 36% were free from disabling seizures (Engel class I) and further 14% were classified Engel II after one year, 45% (I) and 18% (II) in period B and 56% (I) and 18% (II) in period C.

Conclusions: Epilepsy surgery has become a widely accepted treatment option for medically intractable epilepsy due to FCD in children with a favourable outcome in 74% of the young patients in specialized centers and after extensive preoperative diagnostics.