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Epilepsia
Article . 2024 . Peer-reviewed
License: CC BY NC
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PubMed Central
Article . 2024
License: CC BY NC
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ZENODO
Article . 2024
License: CC BY
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A new perspective on drug‐resistant epilepsy in children with focal cortical dysplasia type 1: From challenge to favorable outcome

Authors: Splítková, Barbora; Macková, Kateřina; Koblížek, Miroslav; Holubova, Zuzana; Kyncl, Martin; Bukačová, Kateřina; Maulisova, Alice; +12 Authors

A new perspective on drug‐resistant epilepsy in children with focal cortical dysplasia type 1: From challenge to favorable outcome

Abstract

Abstract Objective We comprehensively characterized a large pediatric cohort with focal cortical dysplasia (FCD) type 1 to expand the phenotypic spectrum and to identify predictors of postsurgical outcomes. Methods We included pediatric patients with histopathological diagnosis of isolated FCD type 1 and at least 1 year of postsurgical follow‐up. We systematically reanalyzed clinical, electrophysiological, and radiological features. The results of this reanalysis served as independent variables for subsequent statistical analyses of outcome predictors. Results All children ( N = 31) had drug‐resistant epilepsy with varying impacts on neurodevelopment and cognition (presurgical intelligence quotient [IQ]/developmental quotient scores = 32–106). Low presurgical IQ was associated with abnormal slow background electroencephalographic (EEG) activity and disrupted sleep architecture. Scalp EEG showed predominantly multiregional and often bilateral epileptiform activity. Advanced epilepsy magnetic resonance imaging (MRI) protocols identified FCD‐specific features in 74.2% of patients (23/31), 17 of whom were initially evaluated as MRI‐negative. In six of eight MRI‐negative cases, fluorodeoxyglucose–positron emission tomography (PET) and subtraction ictal single photon emission computed tomography coregistered to MRI helped localize the dysplastic cortex. Sixteen patients (51.6%) underwent invasive EEG. By the last follow‐up (median = 5 years, interquartile range = 3.3–9 years), seizure freedom was achieved in 71% of patients (22/31), including seven of eight MRI‐negative patients. Antiseizure medications were reduced in 21 patients, with complete withdrawal in six. Seizure outcome was predicted by a combination of the following descriptors: age at epilepsy onset, epilepsy duration, long‐term invasive EEG, and specific MRI and PET findings. Significance This study highlights the broad phenotypic spectrum of FCD type 1, which spans far beyond the narrow descriptions of previous studies. The applied multilayered presurgical approach helped localize the epileptogenic zone in many previously nonlesional cases, resulting in improved postsurgical seizure outcomes, which are more favorable than previously reported for FCD type 1 patients.

Country
Czech Republic
Keywords

Male, Drug Resistant Epilepsy, Epilepsy, Adolescent, Focal cortical dysplasia type 1, Drug-resistant epilepsy, Infant, Electroencephalography, Magnetic Resonance Imaging, Cohort Studies, Focal Cortical Dysplasia, Treatment Outcome, Epilepsy surgery, Child, Preschool, Malformations of Cortical Development, Group I, Positron-Emission Tomography, Paediatric patients, Humans, Female, Child, Multi-layered Diagnostic Protocol, Research Article, Follow-Up Studies

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
7
Top 10%
Average
Top 10%
Green
hybrid