ObjectiveTo make the model of Wistar suckling rats Focal cortical dysplasia (FCD) by liquid nitrogen freezing brain cortex and verify it. Analysed the electroencephalogram (EEG) and magnetic resonance imaging (MRI) features of the FCD model, in order to provide theoretical and experimental basis for human FCD diagnosis and treatment. MethodsTake the first day of Wistar suckling rats as experimental object, liquid nitrogen freezing Wistar suckling rats brain cortex.Make examination of EEG and MRI for Wistar suckling rats. The Brain tissue slice of Wistar suckling rats model dyed by HE and check with light microscope examination. ResultsIn experiment group, the sample epileptic discharge rate of EEG was about 41.6% on average, and showed visible spike wave, spine slow wave frequency distribution. Experimental Wistar suckling rats MRI showed positive performance for long T1 and long T2 signal, brain tissue slices HE staining showed brain cortex layer structure and columnar structure disorder, exist abnormal neurons and the balloon sample cells. ConclusionThe method of liquid nitrogen freezing Wistar suckling rats cortex can established FCDⅢd animal models successfully, and showed specific EEG and MRI, which has important value for diagnosis and treatment of human FCD.
ObjectiveTo explore the prognostic factors for seizure control in focal cortical dysplasia(FCD)by analyzing the clinical features of FCD patients. MethodsWe conducted a follow-up study of patients, who were confirmed FCD by pathology after resective surgery,in Epileptic Center, Guangdong Sanjiu Brain Hospital, From January 1, 2014 to December 31, 2014. All patients were followed at least 6 months,they were divided into seizure control group(Engel class I) and seizure group(Engel classⅡ-class Ⅳ) according to surgical outcomes. Clinical features,auxiliary examinations and pathological classification were compared between two groups. Results102 patients were included, male 65 cases (63.7%), female 37 cases (36.3%), onset age 0.01~45 years old, average (10.3±8.26) years old, surgery age (3~47) years old, average (21.21±8.9) years old, all had seizure onset. 83 (81.4%) patients in seizure control group, 19 (18.6%) patients in seizure group. There are 14.5% of the patients' onset ages are younger than 3 years old, 59.8% preoperative electroencephalogram recording a diffusion epileptiform discharge, 32.5% orientation of magnetic resonance imaging (MRI) and electroencephalography (EEG) is inconsistent, 49.4% postoperative electroencephalogram (EEG) reveal an epileptiform discharge, 45.2% of the patients had intellectual disability, 36.1% had an absence of a lesion on MRI, in seizure control group. However,in seizure group they respectively 36.8%, 72.2%, 89.5%, 68.4%,94.1%, 89.5%. Patients in seizure control group got an average scores of (89.4±18.53) in performance intelligence quotient (PIQ)test, while, seizure group 65.80±15.71.There has a statistical significance between two groups. ConclusionPostoperative seizure outcome was favorable in patients with FCD, onset ages younger 3 years old, intellectual disability,getting a lower scores in PIQ test, preoperative electroencephalogram recording a diffusion epileptic discharge, inconsistent orientation of MRI and EEG, and postoperative EEG reveal an epileptiform discharge may be predictive for the postoperative outcome.
Objective To investigate the application of Magnetoencephalograph (MEG), Wada test combined with neuronavigation in the surgical treatment of frontal and temporal epilepsy caused by focal cortical dysplasia (FCD ). Methods The epileptogenic focus and IQ, memory and language examination were performed in 34 patients with frontal and temporal epilepsy caused by FCD. MEG and Wada test were conducted to determine the language and memory advantage hemisphere, and to clarify the scope and memory function of language function areas. Operation was guided by the Medtronic stealhealth 7 surgical navigation system (USA) to remove the FCD and protect nerve function. IQ, memory and language examination were measured 1 year after operation, and the difference was observed before and after operation. The postoperative follow-up was 23 ~ 46 months, curative effect of epilepsy was determined according to the international anti-epilepsy union Engel’s standard. Results Thirty-four patients with epilepsy (21 temporal lobe epilepsy and 13 frontal lobe epilepsy) were included in this study. The examination process of MEG and Wada test was smooth. MEG can accurately locate the position of language function area. Twenty-eight patients’ dominant hemisphere of language was on the left and 6 was on the right side. Wada test can evaluate the patient’s memory function. Twenty-three patients’ dominant hemisphere of memory was located on the left, 8 on the right and 3 on the bilateral hemisphere. Compared with the dominant hemisphere and nondominant hemisphere, the memory score was significantly different (P<0.05). Statistics showed that the verbal IQ and total IQ increased (P<0.05)1 year after operation, but there was no significant change in memory IQ and Performance IQ (P>0.05). FCD patients recovered well without language, memory and limb impairment. The curative effect of epilepsy: 15 cases of Engel’sⅠgrade, 14 cases of Engel’sⅡgrade and 5 cases of Engel’s Ⅲ grade. Conclusion MEG, Wada test combined with neuronavigation was of important value in locating and guiding the surgical resection of FCD in patients with refractory frontal and temporal epilepsy, protecting cortical function, avoiding severe postoperative complications, and improving the therapeutic effect of epilepsy.
ObjectiveWe report a special case to explain seizure semiology and epileptogenic network of seizure arising from ventral motor cortex, and to explore Focal cortical dycplasia (FCD) features on MR of epileptic patients with DEPDC5 mutation.MethodsA drug-resistant focal epilepsy patient with DEPDC5 mutation was underwent a detailed presurgical evaluation. The epileptogenic area(EA) was localized with SEEG and removed later by surgery. Related literatures were thoroughly reviewed.ResultsSubtle FCD of ventral branch of inferior precentral sulcus(IPv) on MR(1.5T) was noticed. With SEEG recording, seizure onset zone was detected on IPv with the probable lesion, early spreading to anterior insula, central operculum and ventral precentral gyrus. According to the architectures of ventral motor trend, seizure semiology with evolution from contralateral dystonia to ipsilateral chorea movement could be better comprehended. Seizure was controlled after totally resection on the sites of IPv, anterior insula, and central operculum. Pathological change was FCD type I. Other literatures reported that DEPDC5 mutation related FCD may be located in motor system, and seizure onset could also be in anterior insula cortex besides motor cortex in other SEEG cases.ConclusionsEarly contralateral dystonia and chorea movement could be definite figures of seizure arising from inferior precentral sulcus; DEPDC5 mutation maybe a clue to find subtle FCD in motor cortex.
ObjectiveTo discuss the 3D high resolution Magnetic resonance imaging (MRI) features of focal cortical dysplasia (FCD) in children.MethodsMRI data of 42 children with FCD confirmed by pathology, from April 2015 to June 2018, which were admitted to Qilu Children’s Hospital of Shandong University, were retrospectively analyzed. The following MRI signs were observed, blurring of junction of the gray matter-white matter, abnormality of structure with focal cortex (thick or thin), gray matter and white matter signal, white matter signal increased with T2WI/FLAIR, with or without transmantle sign (abnormal signal of white matter extending in the direction of ventricle), gray matter signal increased with T2WI/FLAIR, the abnormal sulci or gyri morphology and segmental and/or hypoplasia/atrophy of the lobes.ResultsAmong the 42 cases, 37 cases (88.1%) showed MRI positive signs, FCD typeⅠ accounted for 13 cases (35.1%), the main MRI features are focal blurring of junction in the gray matter-white matter, abnormality of structure with focal cortex in the corresponding part,and white matter signal increased with T2WI/FLAIR. FCD TypeⅡ accounted for 17 cases (45.9%), the MRI features are focal blurring of junction in the gray matter-white matter, abnormality of structure with focal cortex, white matter signal increased with T2WI/FLAIR, and transmantle sign. FCD TypeⅢ accounted for 7 cases (18.9%), among which hippocampal atrophy 2 cases (28.6%), dysembryoplastic neuroepithelial tumor (DNET) 2 cases (28.6%), section cell tumor 1 case (14.3%), softening lesion with gliosis 2 cases (28.6%).ConclusionThe 3D high-resolution MRI features of FCD in children are specific and could improve the detection rate of FCD lesions.
ObjectiveTo explore the value of high-resolution Magnetic resonance imaging (MRI) imaging in predicting the surgical effect of Focal cortical dysplasia (FCD) in children.MethodsThe MRI and clinical data of 143 children with FCD confirmed by surgery and pathology in Qilu Children’s Hospital of Shandong University from July 2013 to July 2018 were analyzed retrospectively, and the MRI signs were analyzed, and the patients were grouped according to different signs to analyze the satisfaction of postoperative epilepsy control in each group.ResultsAmong the 9 groups of children, MRI signs in the group with better postoperative epilepsy control were those with obvious focal gray matter blurring and cortical thickening and combined with Transmantle sign. The MRI signs in the group with poor postoperative results were mild focal gray matter blurring and cortical structure thinning, and those with abnormal sulcus and gyrus morphology, the postoperative effect of patients with only abnormal sulci and gyrus as the main MRI manifestations was significantly better than those with other signs, and the above differences were statistically significant (P<0.05).ConclusionThe high-resolution MRI of children with FCD had a certain specificity, and it is feasible to predict the satisfaction of postoperative epilepsy control from the perspective of MRI signs, which is an important indicator of surgical prognosis.
ObjectiveTo analyze the causes of unrelieved epilepsy thoroughly in children with isolated focal cortical dysplasia (FCD) based on MRI.MethodsRetrospective 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.ResultsAmong 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.ConclusionMRI 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.
Objective Discussed the postoperative seizure control situation of children with focal cortical dysplasia (FCD),which took Transmantle sign (T2WI or T2 FLAIR sequence inward extension cone high signal in the direction of ventricle) as the main MRI performance, and analyzed the influence of various factors on the prognosis of surgery.MethodsRetrospective analysis was performed on 56 children with FCD with Transmantle signs as the main MRI signs confirmed by pathology in Qilu Children's Hospital of Shandong University from May 2015 to March 2020, including 33 males and 23 females, with an average age of (4.8±0.13) years old, and their imaging and clinical data were analyzed. Analyzed the pathological types and main MRI signs, the range of epileptiform discharge, and Engel classification after surgery. Analyzed the effect of surgical method, type of onset, age of operation, epileptic site, course of disease and perioperative epileptic seizure on the surgical prognosis of children.ResultsPostoperative pathology showed that all the 56 cases both were FCDⅡb, in addition to the Transmantle sign, the MRI performance were also accompanied by focal blurring of gray and white matter, abnormal cortical structure, and abnormal signal foci in gray and white matter. Intraoperative EEG monitoring results showed that the epileptiform discharge area in all cases was larger than the lesion range showed by MRI. Postoperative Engel classification: 25 cases of gradeⅠ (43.8%), 18 cases of gradeⅡ (31.3%), 4 case of gradeⅢ (6.3%), 9 cases of gradeⅣ (18.8%). Surgical resection and perioperative seizures are independent factors affecting the prognosis of children (P<0.05).Conclusionsurgical methods and perioperative seizures were closely related to the prognosis of children.
ObjectiveTo explore the microscopic character and clinical pathological feature of focal cortical dysplasia (FCD).Methods51 cases were collected from January 2015 to September 2018 in the 988th Hospital of the Joint Logistics Support Force of the People’s Libereation Army. Pathology with FCD of their diseased brain tissue was classified according to the classification standard by the International Anti-Epilepsy Union (ILAE) in 2011. Epileptic seizure characteristics were analysed in different types.ResultsFCD I was 23 cases (45.1%). FCD II was 11 (21.6%). FCD III was 17 (33.3%). Ia was the most common type (23.5%, 12/51). Neurons were arranged into microcolumnar structures in Ia. NF expression in immunohistochemistry was characteristic. It was close to the neuron like line or waterfall. The second type was Ⅲa (15.7%, 8/51). Hippocampal sclerosis was given priority to CA4 area pyramidal cells to reduce or disappear. Three types all happened in bilateral cerebral hemisphere. There was no statistical difference. Temporal lobe was significantly more than frontal lobe. More than 50% of the cases occurredepilepsy before the age of 18. The main manifestation was partial onset seizures and secondary body stiffness clonus. The onset age and history of epilepsy in patients with FCD Ⅲ were earlier than those in the other two types. On image the positive rate of I type was 78.3% and that of Ⅱ and Ⅲ was both 100%.ConclusionFCD is a common pathological feature of epilepsy patients. Carefully pathologic examination is the premise of accurate classification of each subtype. Ⅲ type is different from Ⅰ and Ⅱ type in epileptic seizures.