Analysis of focal cortical dysplasia with children whose epilepsy was unrelieved thoroughly after operation based on MRI_Journal of Epilepsy

Authors：

LI Lin , YI Minggang , LIU Yong , CUI Ruodi , DONG Chunhua , GAO Xin ,  ZHAO Jianshe

The Center of Medical Imaging, Qilu Children’s Hospital of Shandong University, Jinan 250022, China;

Corresponding author：

ZHAO Jianshe, Email: zhaojianshe@163.com

Keywords：

Children; Focal cortical dysplasia; Magnetic resonance imaging; Neurosurgical procedure; Unrelieved epilepsy

DOI：

10.7507/2096-0247.20210080

Video：

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Objective To analyze the causes of unrelieved epilepsy thoroughly in children with isolated focal cortical dysplasia (FCD) based on MRI.Methods Retrospective analysis of MRI and clinical data of 21 children with isolated FCD during July 2014 to January 2018, which confirmed by pathology and unrelieved thoroughly after operation performed, the pathological types and MRI signs were analyzed, as well as the frequency of different MRI signs in FCD of each pathological type. Analyzed the possible factors of surgical failure.Results Among the 21 cases, there were 15 males and 6 females, with an average age of (5.7±0.3) years and an average course of disease of (3.4±0.5) years.MRI signs of this part of the children were mainly manifested by blurred focal gray matter boundaries, abnormal cortical structure changes (thickening and/or thinning), transmantle signs (abnormal cone signals extending from subcortical white matter to the ventricle) and abnormal gray matter signals, which were similar to MRI signs of FCD with satisfactory postoperative epilepsy control. 17 cases (80.9%) appeared epileptic discharge after operation in the EEG monitoring area 2 weeks to 6 months, FCD type I and type Ⅱ accounted for 35.3%, 64.7% respectively. During intraoperative EEG monitoring, no epileptiform discharge was observed in the transmantle sign region in 6 cases, and the region was retained, and only the surrounding abnormal discharge cortex was removed, complete removal of the tansmantle sign and surrounding abnormal discharge area was performed in 2 cases, and different degrees of epileptic epilepsy were observed in both methods.Conclusion MRI signs of isolated FCD with unrelieved epilepsy after operation were nonspecific, there were still epilepsy of varying degrees after all epileptogenic lesions have been removed, the cause may be related to potential epileptic factors.

Citation： LI Lin, YI Minggang, LIU Yong, CUI Ruodi, DONG Chunhua, GAO Xin, ZHAO Jianshe. Analysis of focal cortical dysplasia with children whose epilepsy was unrelieved thoroughly after operation based on MRI. Journal of Epilepsy, 2021, 7(6): 492-496. doi: 10.7507/2096-0247.20210080 Copy

1.	Blümcke I, Thom M, Aronica E, et al. The clinicopathologic spectrum of focal cortical dysplasias: A consensus classification proposed by an ad hoc task force of the ILAE diagnostic methods commission. Epilepsia, 2011, 52(1): 158-174.
2.	Kakita A. Surgical pathologic features of cerebral cortical lesions taken from 600 patients with intractable epilepsy. Brain Dev, 2013, 35(8): 793-801.
3.	Jayalakshmi S, Nanda SK, Vooturi S, et al. Focal cortical dysplasia and refractory epilepsy: Role of multimodality imaging and outcome of surgery. AJNR Am J Neuroradiol, 2019, 40(5): 892-898.
4.	Mata-Mbemba D, Iimura Y, Hazrati LN, et al. MRI, magnetoencephalography, and surgical outcome of oligodendrocytosis versus focal cortical dysplasia Type I. AJNR Am J Neuroradiol, 2018, 39(12): 2371-2377.
5.	Guye M, Bartolomei F, Ranjeva JP. Malformations of cortical development: The role of 7-Tesla magnetic resonance imaging in diagnosis. Rev Neurol(Paris), 2019, 175(3): 157-162.
6.	Hong SJ, Bernhardt BC, Caldairou B, et al. Multimodal MRI profiling of focal cortical dysplasia type II. Neurology, 2017, 88(8): 734-742.
7.	Veersema TJ, Ferrier CH, van Eijsden P, et al. Seven tesla MRI improves detection of focal cortical dysplasia in patients with refractory focal epilepsy. Epilepsia Open, 2017, 2(2): 162-171.
8.	Choi SA, Kim KJ. The Surgical and cognitive outcomes of focal cortical dysplasia. J Korean Neurosurg Soc, 2019, 62(3): 321-327.
9.	Tassi L, Garbelli R, Colombo N, et al. Electroclinical, MRI and surgical outcomes in 100 epileptic patients with type II FCD. Epileptic Disord, 2012, 14(3): 257-266.
10.	Colombo N, Tassi L, Deleo F, et al. Focal cortical dysplasia type Ⅱa and Ⅱb: MRI aspects in 118 cases proven by histopathology. Neuroradiology, 2012, 54(10): 1065-1077.
11.	Widjaja E, Otsubo H, Raybaud C, et al. Characteristics of MEG and MRI between Taylor's focal cortical dysplasia (type II) and other cortical dysplasia: surgical outcome after complete resection of MEG spike source and MR lesion in pediatric cortical dysplasia. Epilepsy Res, 2008, 82(2-3): 147-155.
12.	林元相, 林堃, 康德智, 等. 局灶性皮质发育不良相关性难治性癫痫的手术预后及其相关影响因素分析. 中华医学杂志, 2012, 92(25): 1763-1766.
13.	Noli D, Bartuluchi M, González FS, et al. Type II focal cortical dysplasia: electroclinicalstudy and surgical outcome in 31 pediatric patients. Childs Nerv Syst, 2013, 29(11): 2079-87.
14.	Kim DW, Lee SK, Chu K, Park KI, et al. Predictors of surgical outcome and pathologic considerations in focal cortical dysplasia. Neurology, 2009, 72(3): 211-216.
15.	Mrelashvili A, Witte RJ, Wirrell EC, et al. Seizure freedom in children with pathology-confirmed focal cortical dysplasia. Pediatr Neurol, 2015, 53(6): 513-518.
16.	王逸鹤, 赵国光, 单永治, 等. 局灶性皮质发育不良致药物难治性癫痫的手术预后及其影响因素. 中国临床神经外科杂志, 2017, 22(11): 737-740.
17.	Jin B, Wang J, Zhou J, et al. A longitudinal study of surgical outcome of pharmacoresistat epilepsy caused by focal cortical dysplasia. J Neurol, 2016, 263(12): 2403-2410.
18.	Chern JJ, Patel AJ, Jea A, et al. Surgical outcome for focal cortical dysplasia: an analysis of recent surgical series. A review. J Neurosurg Pediatr, 2010, 6(5): 452-458.
19.	Bourdillon P, Rheims S, Catenoix H, et al. Malformations of cortical development: New surgical advances. Rev Neurol (Paris), 2019, 175(3): 183-188.

1. Blümcke I, Thom M, Aronica E, et al. The clinicopathologic spectrum of focal cortical dysplasias: A consensus classification proposed by an ad hoc task force of the ILAE diagnostic methods commission. Epilepsia, 2011, 52(1): 158-174.
2. Kakita A. Surgical pathologic features of cerebral cortical lesions taken from 600 patients with intractable epilepsy. Brain Dev, 2013, 35(8): 793-801.
3. Jayalakshmi S, Nanda SK, Vooturi S, et al. Focal cortical dysplasia and refractory epilepsy: Role of multimodality imaging and outcome of surgery. AJNR Am J Neuroradiol, 2019, 40(5): 892-898.
4. Mata-Mbemba D, Iimura Y, Hazrati LN, et al. MRI, magnetoencephalography, and surgical outcome of oligodendrocytosis versus focal cortical dysplasia Type I. AJNR Am J Neuroradiol, 2018, 39(12): 2371-2377.
5. Guye M, Bartolomei F, Ranjeva JP. Malformations of cortical development: The role of 7-Tesla magnetic resonance imaging in diagnosis. Rev Neurol(Paris), 2019, 175(3): 157-162.
6. Hong SJ, Bernhardt BC, Caldairou B, et al. Multimodal MRI profiling of focal cortical dysplasia type II. Neurology, 2017, 88(8): 734-742.
7. Veersema TJ, Ferrier CH, van Eijsden P, et al. Seven tesla MRI improves detection of focal cortical dysplasia in patients with refractory focal epilepsy. Epilepsia Open, 2017, 2(2): 162-171.
8. Choi SA, Kim KJ. The Surgical and cognitive outcomes of focal cortical dysplasia. J Korean Neurosurg Soc, 2019, 62(3): 321-327.
9. Tassi L, Garbelli R, Colombo N, et al. Electroclinical, MRI and surgical outcomes in 100 epileptic patients with type II FCD. Epileptic Disord, 2012, 14(3): 257-266.
10. Colombo N, Tassi L, Deleo F, et al. Focal cortical dysplasia type Ⅱa and Ⅱb: MRI aspects in 118 cases proven by histopathology. Neuroradiology, 2012, 54(10): 1065-1077.
11. Widjaja E, Otsubo H, Raybaud C, et al. Characteristics of MEG and MRI between Taylor's focal cortical dysplasia (type II) and other cortical dysplasia: surgical outcome after complete resection of MEG spike source and MR lesion in pediatric cortical dysplasia. Epilepsy Res, 2008, 82(2-3): 147-155.
12. 林元相, 林堃, 康德智, 等. 局灶性皮质发育不良相关性难治性癫痫的手术预后及其相关影响因素分析. 中华医学杂志, 2012, 92(25): 1763-1766.
13. Noli D, Bartuluchi M, González FS, et al. Type II focal cortical dysplasia: electroclinicalstudy and surgical outcome in 31 pediatric patients. Childs Nerv Syst, 2013, 29(11): 2079-87.
14. Kim DW, Lee SK, Chu K, Park KI, et al. Predictors of surgical outcome and pathologic considerations in focal cortical dysplasia. Neurology, 2009, 72(3): 211-216.
15. Mrelashvili A, Witte RJ, Wirrell EC, et al. Seizure freedom in children with pathology-confirmed focal cortical dysplasia. Pediatr Neurol, 2015, 53(6): 513-518.
16. 王逸鹤, 赵国光, 单永治, 等. 局灶性皮质发育不良致药物难治性癫痫的手术预后及其影响因素. 中国临床神经外科杂志, 2017, 22(11): 737-740.
17. Jin B, Wang J, Zhou J, et al. A longitudinal study of surgical outcome of pharmacoresistat epilepsy caused by focal cortical dysplasia. J Neurol, 2016, 263(12): 2403-2410.
18. Chern JJ, Patel AJ, Jea A, et al. Surgical outcome for focal cortical dysplasia: an analysis of recent surgical series. A review. J Neurosurg Pediatr, 2010, 6(5): 452-458.
19. Bourdillon P, Rheims S, Catenoix H, et al. Malformations of cortical development: New surgical advances. Rev Neurol (Paris), 2019, 175(3): 183-188.

Journal of Epilepsy

Analysis of focal cortical dysplasia with children whose epilepsy was unrelieved thoroughly after operation based on MRI

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