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Focal cortical dysplasia: Long-term seizure outcome after surgical treatment
  1. Thomas Kral (thomas.kral{at}ukb.uni-bonn.de)
  1. Department of Neurosurgery, Germany
    1. Marec von Lehe (marc.vonlehe{at}ukb.uni-bonn.de)
    1. Department of Neurosurgery, Germany
      1. Martin Podlogar (martin.podlogar{at}ukb.uni-bonn.de)
      1. Department of Neurosurgery, Germany
        1. Hans Clusmann (hans.clusmann{at}ukb.uni-bonn.de)
        1. Department of Neurosurgery, Germany
          1. Petra Süßmann (petra.suessmann{at}ukb.uni-bonn.de)
          1. Department of Neurosurgery, Germany
            1. Martin Kurthen
            1. Swiss Epilepsy center, Switzerland
              1. Albert Becker (albert.becker{at}ukb.uni-bonn.de)
              1. Department of Neuropathology, Germany
                1. Horst Urbach (horst.urbach{at}ukb.uni-bonn.de)
                1. Department of Neuroradiology, Germany
                  1. Johannes Schramm (johannes.schramm{at}ukb.uni-bonn.de)
                  1. Department of Neurosurgery, Germany

                    Abstract

                    Objective: Studies of long-term outcome after epilepsy surgery of cortical malformations are rare (1-3). In this study, the authors report their experience with surgical treatment and year-to-year long-term outcome for a subgroup of patients with focal cortical dysplasia (FCD).

                    Methods: We retrospectively analysed the records of 49 patients (female: N = 26; male: N = 23; mean age: 25 ± 11 years) with a mean duration of epilepsy of 18 years (range: 1–45 years). A preoperative MRI, histological results according to the Palmini classification (4) and clinical year-to-year follow-up according to the International League Against Epilepsy (ILAE) – classification (5) were available in all patients.

                    Results: 98% had a lesion on preoperative MRI. In addition to lobectomy (N = 9) or lesionectomy (N = 40), 14 patients had multiple subpial transections of eloquent cortex. The resected tissue was classified as FCD type II b in 41 cases with extratemporal (88%) and FCD type II a in 8 cases with temporal localization (100%). After a mean follow up of 8.1 ± 4.5 years, 37 patients (76%) were seizure free, a subgroup of 23 patients (47%) was completely seizure free since surgery (ILAE class 1a) and 4 patients (8%) had only auras (ILAE class 2). During a ten years follow up the proportion of satisfactory outcome decreased mainly within the first three years. 48% stopped AED treatment, 34% received driving drivers license and 57% got a job or training during long term follow up.

                    Conclusion: Surgical treatment of epilepsy with FCD has not only a successful short-term result but also a satisfying long-term outcome which keeps constant after three years of follow up but not associated with a better employment status or improvement of daily living.

                    • cortical dysplasia
                    • epilepsy surgery
                    • long term follow up
                    • year to year follow up

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