gms | German Medical Science

Objective: Focal cortical dysplasia (FCD) is regarded as a major cause of pharmaco-resistant focal epilepsy, thus frequently becoming object to neurosurgical treatment. Following extensive epileptological assessment, resective lesionectomy, lobectomy or multilobectomy was carried out. In this study, we aim to give an overview on the epileptological long-term outcome in 113 patients with FCD.

Methods: In the period of 2000-2012 overall 249 patients (mean age 22.2y) with neuropathologically confirmed FCD underwent resective epilepsy surgery. Among these, 113 patients were postoperatively followed-up >5 years (follow-up period 5-15y, mean 6.6y) in our institutions and included in this study. Analysis of perioperative complications and epileptological long-term outcome was carried out in all patients. FCD (n=113) was localized extratemporal in n=53/46.9%, temporal in n=37/32.7% and combined temporal/extratemporal in n=23/20.4%; neuropathological classification revealed FCD I (ILAE) in n=26/23%, FCD II in n=61/54% and FCD III in n=14/12.4%, others were not clearly classified.

Results: The overall outcome of the patients available for long-term follow-up >5 years was favorable. Outcome was correlated to age at surgery, pathology and anatomical location of the lesion. Overall n=56/49.6% remained completely seizure-free (Engel Ia) for the entire follow-up period up to 15 years postoperatively, whereas n=97/85.8% experienced a worthwhile seizure reduction Engel I-III). In extratemporal FCD, the neuropathological subtype FCD II (n=32) revealed a favorable outcome with significant long-term seizure control in n=29/87.9% compared to FCD I (n=12) with n=10/83.3%. In temporal FCD, significant long-term seizure freedom was observed comparably in FCD I (n=7) with n=6/85.7%, FCD II (n=15) with n=14/93.3% and FCD III (n=11) with n=11/100%. Although combined temporal and extratemporal surgery reflects more complicated epileptological conditions, significant seizure reduction could be achieved in FCD I with n=5/71.4%, in FCD II with n=10/76.9% and FCD III with n=2/100%. There was no operative mortality. Perioperative complications were rare and predominantly without major permanent deficit (5.3%).

Conclusion: Based on our experience, resective surgery of FCD is a favorable therapeutic option in pharmaco-resistant epilepsy revealing high chances for long-term seizure freedom or significant seizure reduction. Higher FCD grade in extratemporal lesions or temporal location predict a favorable long-term outcome.