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Isler C, Kucukyuruk B, Ozkara C, Gunduz A, Is M, Tanriverdi T, Comunoglu N, Oz B, Uzan M. Comparison of clinical features and surgical outcome in focal cortical dysplasia type 1 and type 2. Epilepsy Res 2017; 136:130-136. [PMID: 28850830 DOI: 10.1016/j.eplepsyres.2017.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/09/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Recent ILAE classification defined focal cortical dysplasia (FCD) patients with accompanying epileptic lesions as a separate group. We investigated data of patients with sole FCD lesions regarding long-term seizure outcome and different characteristics of FCD type 1 and type 2 patients. METHODS Eighty children and adult patients underwent surgery for FCD were included to the analysis of factors differentiating FCD type 1 and type 2 groups and their effect on long-term outcome. RESULTS FCD type 2 patients had earlier epilepsy onset (8.1 vs. 6.1 years. p=0.019) and underwent surgery younger than type 1 (18.2 vs. 23.7 years. p=0.034). FCD type 2 patients were more prominently MR positive (77.8% vs. 53.8%. p=0.029), which increased within FCD type 2 group as patients become younger (p=0.028). FCD Type 1 lesions showed mostly multilobar extension and FCD type 2 mostly located in frontal lobe. Seizure freedom was achieved in 65.4% of FCD type 1 patients and 70.4% of FCD type 2 patients. Seven patients had permanent de novo neurological deficits. Mean follow-up time was 5.5 years (Range: 1-11 years). CONCLUSION Surgical intervention in carefully selected patients may facilitate favorable seizure outcome leading to better quality of life. FCD type 1 and type 2 groups present with evident differences, which may promote medical and surgical management of these pathologies.
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Affiliation(s)
- Cihan Isler
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Baris Kucukyuruk
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Cigdem Ozkara
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aysegul Gunduz
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Merih Is
- Department of Neurosurgery, Fatih Sultan Mehmet Research and Education Hospital, Health Sciences University, Istanbul, Turkey
| | - Taner Tanriverdi
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nil Comunoglu
- Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Buge Oz
- Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Uzan
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Huang C, Zhang H, Chi XS, Chen N, Gong J, Zhou Q, Blümcke I, Zhou D, Li JM. Putting the new ILAE classification of focal cortical dysplasia into practice in western China. Seizure 2017; 51:133-138. [PMID: 28843774 DOI: 10.1016/j.seizure.2017.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To re-examine drug-resistant epilepsy cases using the revised 2011 ILAE classification of focal cortical dysplasia (FCD). METHODS Patients with drug-resistant epilepsy who have undergone epilepsy surgery in West China Hospital between July 2012 and Jun 2014 were included. Clinical histories, pathological diagnoses, and surgical outcomes were reviewed. A questionnaire was developed to investigate the clinical practice of the new classification. A short-term training program on FCD was carried out to improve pathological diagnosis accuracy. RESULTS 260 consecutive cases (177 male and 83 female) were included. Pathological diagnosis was changed in 70 cases (26.9%) after re-examination. The five most common pathological types were hippocampal sclerosis (19.2%, 50/260), brain tumors (17.7%, 46/260), vascular malformations (16.2%, 42/260), glial scars (11.2%, 29/260) and FCD (10.0%, 26/260). The most common subtype of isolated FCD was FCD IIb (53.8%, 14/26), followed by FCD IIa (42.3%, 11/26) and FCD Ib (3.8%, 1/26). In addition, forty-five cases were diagnosed as associated FCD type III (17.3%, 45/260). Half of patients with FCD achieved Engel class I at two-year follow-up. Questionnaire investigation suggested most participant pathologists lack sufficient knowledge on the new classification. The diagnostic sensitivity for different FCD subtypes was significantly improved by two to six folds after short-term training. CONCLUSIONS FCD is an important etiology of drug-resistant epilepsy in western China. It is essential to provide continuing trainings to improve diagnostic precision of FCD in developing countries.
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Affiliation(s)
- Cheng Huang
- Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China; Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Heng Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao-Sa Chi
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ni Chen
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, 610041,Sichuan, People's Republic of China
| | - Jing Gong
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, 610041,Sichuan, People's Republic of China
| | - Qiao Zhou
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, 610041,Sichuan, People's Republic of China
| | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, 91054, Erlangen, Germany
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jin-Mei Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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Siedlecka M, Grajkowska W, Galus R, Dembowska-Bagińska B, Jóźwiak J. Focal cortical dysplasia: Molecular disturbances and clinicopathological classification (Review). Int J Mol Med 2016; 38:1327-1337. [DOI: 10.3892/ijmm.2016.2760] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 06/23/2016] [Indexed: 11/05/2022] Open
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Martinoni M, Marucci G, Rubboli G, Volpi L, Riguzzi P, Marliani F, Toni F, Naldi I, Bisulli F, Tinuper P, Michelucci R, Baruzzi A, Giulioni M. Focal cortical dysplasias in temporal lobe epilepsy surgery: Challenge in defining unusual variants according to the last ILAE classification. Epilepsy Behav 2015; 45:212-6. [PMID: 25812941 DOI: 10.1016/j.yebeh.2015.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/10/2015] [Accepted: 01/12/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Focal cortical dysplasias (FCDs) represent a common architectural cortical disorder underlying pharmacoresistant focal epilepsy. The recent ILAE classification defines different types of FCDs based on their histopathological features, MRI imaging, and presumed pathogenesis; however, their clinical features and their prognostic significance are still incompletely defined. In addition, the combination of different histopathological abnormalities can represent "unusual" subtypes that can be difficult to classify. The aim of our study was to analyze the incidence and the significance of these "unusual" subtypes of FCDs in drug-resistant mesial temporal lobe epilepsy (MTLE). METHODS We retrospectively analyzed 133 patients consecutively submitted to tailored anteromesial temporal lobe resection for pharmacoresistant MTLE. Seizure onset, seizure duration, age at surgery, and postoperative seizure outcome were evaluated in relation to the different neuropathological groups defined according to the new ILAE classification. RESULTS Focal cortical dysplasias were found in 80 out of 133 patients. Six patients were affected by isolated FCD type I, 12 patients by FCD type II, and 44 patients by FCD type III. Furthermore, we found 18 "atypical" cases (20.5% of all FCD cases and 26.6% of FCDs associated with a principal lesion): 10 cases of associated FCD type II-hippocampal sclerosis (HS) and 8 cases associated with FCD II-epilepsy-associated tumors (EATs). CONCLUSION Our results indicate that "unusual" subtypes of FCDs, in particular associated FCD type II, are not uncommon findings, suggesting that they deserve a classification recognition. Similarities in seizure outcome and immunohistochemical and molecular evidences, shared by FCD type II+EATs and EATs, suggest a common pathogenic link. The choice to create a specific unifying class or, on the contrary, to also include "associated FCD type II" in the definition of the new unifying class FCD type III should be further discussed.
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Affiliation(s)
- Matteo Martinoni
- IRCCS Institute of Neurological Science of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy.
| | - Gianluca Marucci
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Section of Pathology "M.Malpighi", Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Guido Rubboli
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy; Danish Epilepsy Centre, Dianalund, Denmark
| | - Lilia Volpi
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Patrizia Riguzzi
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Federica Marliani
- IRCCS Institute of Neurological Sciences of Bologna, Section of Neuroradiology, Bellaria Hospital, Bologna, Italy
| | - Francesco Toni
- IRCCS Institute of Neurological Sciences of Bologna, Section of Neuroradiology, Bellaria Hospital, Bologna, Italy
| | - Ilaria Naldi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Francesca Bisulli
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Paolo Tinuper
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Roberto Michelucci
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Agostino Baruzzi
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Marco Giulioni
- IRCCS Institute of Neurological Science of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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