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

Surgical treatment of children with focal epilepsy due to unilateral polymicrogyria

Operative Behandlung bei Kindern mit fokaler Epilepsie bei hemisphärischer Polymikrogyrie

Meeting Abstract

  • corresponding author M. Kudernatsch - Klinik für Neurochirurgie, Epilepsiechirurgie, Behandlungszentrum Vogtareuth
  • T. Pieper - Klinik für Neuropädiatrie, Epilesiezentrum für Kinder und Jugendliche, Behandlungszentrum Vogtareuth
  • H. Holthausen - Klinik für Neuropädiatrie, Epilesiezentrum für Kinder und Jugendliche, Behandlungszentrum Vogtareuth
  • D. Kolodziejczyk - Klinik für Neurochirurgie, Epilepsiechirurgie, Behandlungszentrum Vogtareuth

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.06.09

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc083.shtml

Published: May 30, 2008

© 2008 Kudernatsch et al.
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Outline

Text

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.