Abstract Details

Title Surgical Outcome and Prognostic Factors in Children with Medically Intractable Epilepsy (MIE) Caused by Focal Cortical Dysplasia (FCD)

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S48 - (-)

Poster/Presentation
Number 004

Objective

Background FCD is the most common cause of MIE in children. Epilepsy surgery (ES) is a gold-standard treatment in these patients (Pt). Seizure freedom is lower if FCD is the cause of MIE. There is controversy surrounding the PF for SO, especially with respect to FCD type.

Design/Methods 82 Pt with histologically proven FCD were retrospectively studied. Pt with FCD who underwent ES for MIE between 2001 and 2008 with ? 4 year follow up were included in the study. Data regarding sex, age at seizure onset (ASO), duration of 1st seizure to surgery (DSS), developmental delay (DD) or mental retardation (MR), presurgical workup, surgery type, completeness of resection (CR - lack of FCD on postoperative MRI and complete resection of epileptogenic zones using intracranial EEG), FCD pathology type and SO were collected. Statistical significance was determined using ordinal logistic regression.

Results 42 Pt were female and 40 were male. Age at surgery ranged from 1 mo to 22 yr (Median 117 mo). Median DSS was 67 mo and follow up was 64 mo. Among 82 Pt, 19 had mild malformation of cortical development, 14 had FCD1, 23 had FCD2 and 26 had FCD3. DD or MR was noted in 44 Pt, CR in 63 Pt, extratemporal FCD in 57 and temporal FCD in 25 Pt. MRI showed FCD in 70 Pt and was nonlesional in 12 Pt. Engle class 1 surgical outcome was noted in 56 Pt (68.3%), Engle class 2 in 20.7%, Engle class 3 in 11%. The only significant prognostic factor was CR (p < 0.0001).

Conclusions These findings strongly suggest consideration of ES in Pt with MIE caused by FCD. CR is the only significant factor for predicting seizure freedom.

Authors/Disclosures
Pramote Laoprasert, MD PRESENTER	No disclosure on file
Andrew M. White, MD (Denver Health Medical Center)	No disclosure on file
David Z. Wang, DO, FAHA, FAAN (BNI, Neurology, Stroke)	Dr. Wang has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Mediwelcome.
Kelly G. Knupp, MD (Children's Hospital Colorado)	The institution of Dr. Knupp has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Harmony. Dr. Knupp has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Epilepsy Research.
	No disclosure on file
Susan P. Koh, MD (Childrens Hospital of Colorado)	No disclosure on file
Kristen Park, MD (Children'S Hospital Colorado)	The institution of Dr. Park has received research support from CURE GRIN. The institution of Dr. Park has received research support from GRIN2B Foundation.
Kevin E. Chapman, MD (Barrow Neurological Institute at Phoenix Children's Hospital)	No disclosure on file
	No disclosure on file
Michael H. Handler, MD, FACS, FAAP (The Children's Hospital)	No disclosure on file

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