Article
Surgical treatment of children with focal epilepsy due to unilateral polymicrogyria
Operative Behandlung bei Kindern mit fokaler Epilepsie bei hemisphärischer Polymikrogyrie
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Published: | May 30, 2008 |
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Objective: Malformations of cortical development are a frequent cause of drug resistant focal epilepsy in children. Unilateral polymicrogyria (upmg) represents a special late-organizational disorder of cortical development. Clinical course of epilepsy and epilepsy related mental retardation as well as the extent of motor handicap of the contralateral side may vary over a wide range which may influence decision making.
We report a group of 10 children with upmg with respect to postoperative seizure outcome, mental situation, motor function of the paretic side and epilepsy associated factors.
Methods: From 1998 - 2007 we operated 232 children with refractory focal epilepsy. A group of 10 children showed the characteristic pattern of upmg. To prove the existence of ipsilateral cortico-spinal projections, all children were examined by transcranial magnet stimulation (TMS). All but one underwent a disconnective procedure (hemispherotomy). In one patient a temporo-parieto-occipital resection was done after invasive monitoring. The postop. seizure outcome (for at least 6 month) was classified according to the Engels Classification (EC).
Results: All 10 male pats. were severely mentaly retarded except for one normal-mildly retarded boy. Postop. 8 children had complete relief from seizures (EC Ia), while 2 had very rare seizures (1 pat. with partial resection of the upmg, 1 pat. unknown cause).
The TMS showed ipsilateral cortico-spinal connections to the paretic hand in 7/10 children.
Conclusions: Children with focal epilepsy due to unilateral polymicrogyria are good candidates for surgical treatment. Beside severe epilepsy, the epilepsy-associated cognitive decline due to secondary bilateral synchrony, the extent of preoperative motor handicap and the existence of cortico-spinal reorganisation may be critical in the decision for the operation.