gms | German Medical Science

Objective: Focal cortical dysplasia (FCD) is a common cause of pharmacoresistant epilepsy. We report the results of epilepsy surgery in our series of 86 children with FCD.

Methods: 86 children (mean age 10 years, range 1–17 years) with histologically proven FCD who were operated between 1998 and 2007 and retrospectively analyzed regarding FCD localization, type of resection, and epileptological outcome. Multivariate statistical analyses were used to assess prognostic significance of clinical variables in the whole series of 120 patients including adult cases.

Results: FCD was located in the temporal lobe in 41 patients, in the frontal lobe in 21 patients, in the occipital lobe in 1 patient, and multilobar in 23 cases. Histologically (classification according to Palmini), 10 patients had FCD type 1a, 29 type 1b, 26 type 2a and 15 type 2b. Six additional patients had mild malformations of the cortical development. Twenty-nine patients underwent temporal lobectomy, 3 patients frontal lobectomy, 2 patients occipital lobectomy, and 1 patient multilobectomy. In addition, 26 patients had unifocal lesionectomy, 1 patient multifocal lesionectomy, and 22 patients extended lesionectomy in the frontal, temporal and/or occipital lobe respectively. Two patients had a lesionectomy and additional multiple subpial transsections. The postoperative outcome was favourable: One year postoperatively 67% of the children were completely seizure-free (Engel Ia). The respective numbers for 2 and 3 years follow-up were 56% and 58%. An analysis of predictive factors in the whole series including adult patients with FCD showed that higher age at epilepsy surgery, the occurrence of secondary generalized tonic-clonic seizures and larger extent of the lesion were statistically significant negative predictors.

Conclusions: The presented data show that epilepsy surgery in children with FCD is efficient. Early age at epilepsy surgery was a significant positive predictor indicating a high chance for complete seizure relief. These data strongly suggest early consideration of epilepsy surgery in children with FCD.