Abstracts

CLINICAL, EEG, MRI AND SURGICAL OUTCOMES OF PEDIATRIC EPILEPSY WITH ASTROCYTIC INCLUSIONS VERSUS FOCAL CORTICAL DYSPLASIA

Abstract number : 1.189
Submission category : 4. Clinical Epilepsy
Year : 2014
Submission ID : 1867894
Source : www.aesnet.org
Presentation date : 12/6/2014 12:00:00 AM
Published date : Sep 29, 2014, 05:33 AM

Authors :
Laila Alshafai, Ayako Ochi, Cristina Go, Blathnaid McCoy, Cynthia Hawkins, Hiroshi Otsubo, O. Carter Snead, James Rutka and Elysa Widjaja

Rationale: Astrocytic inclusions (AI) have been identified on histological specimens of patients with early onset seizures. It is unknown whether there are distinct clinical features and diagnostic tests that could differentiate this entity from the more commonly encountered surgical epileptogenic substrate, focal cortical dysplasia (FCD), among children with medically refractory epilepsy. The aim of this study was to compare the clinical, EEG, magnetoencephalography (MEG), MRI and surgical outcomes of AI relative to FCD. Methods: We assessed the clinical manifestations, semiology, ictal and interictal features on video EEG, MEG, MRI features and surgical outcomes of children with histologically proven AI compared to FCD. Results: Six children had AI and 27 had FCD. Children with AI had earlier age at seizure onset, all had periodic spasms, and interictal epileptiform discharges consisting of a mixture of generalized or diffuse hemispheric slow waves, sharp waves, spikes and polyspikes. Children with FCD were less likely to have spasms (4/27 (15%)) and the morphology of the diffuse hemispheric or generalized discharges were different from AI, consisting of spike-and-waves, polyspike-and-waves, sharp-and-slow waves and paroxysmal fast activity. Patients with AI were less likely to have tightly clustered MEG spike sources (3/6 (50%) versus 23/27 (85%)), more likely to demonstrate abnormal sulcation and gyration pattern (4/6 (67%) versus 2/27 (7%)) and gray matter heterotopia (2/6 (33%) versus 0/27 (0%)) than FCD. Four children with AI had resection and two had biopsy but did not undergo resection. Children with AI had lower rates of seizure freedom after surgery compared to FCD (1/4 (25%) versus 15/27 (56%) respectively). Conclusions: Although there were some similarities between AI and FCD, patients with AI were more likely to present with early onset periodic spasms, have unusual interictal epileptiform discharges, abnormal sulcation and gyration pattern and gray matter heterotopia, and less likely to be seizure free following surgical resection relative to FCD. Further study with a larger sample size is needed to validate our findings.
Clinical Epilepsy