POSTOPERATIVE PROGNOSIS IN ADULT PATIENTS WITH MALFORMATIONS OF CORTICAL DEVELOPMENT AFTER RESECTIVE EPILEPSY SURGERY
Abstract number :
2.452
Submission category :
Year :
2005
Submission ID :
5759
Source :
www.aesnet.org
Presentation date :
12/3/2005 12:00:00 AM
Published date :
Dec 2, 2005, 06:00 AM
Authors :
2Nese Dericioglu, 1Serap Saygi, 3Figen Soylemezoglu, 4Oguz Cataltepe, 5Aysenur Cila, 2Abdurrahman Ciger, and 4Nejat Akalan
With improvement in neuroradiological techniques, malformations of cortical development (MCD) are beeing recognized more frequently as a cause of seizures in patients with epilepsy. Since these seizures are usually drug resistant, surgery is performed in selected cases. In this study we aimed to find out what the prognosis, in terms of seizure outcome, would be in patients with MCD after resective epilepsy surgery (RES). Adult patients who underwent RES in our institution after 1992, had MCD and were followed-up for minimum 1 year postoperatively were included in the study. All patients except 2 underwent surgery after noninvasive presurgical investigation (scalp ictal-interictal EEG, detailed MRI investigation and ictal-interictal SPECT when indicated). Clinical characteristics and laboratory findings were reviewed retrospectively. Seizure outcome was based on Engel[apos]s classification. Ten patients had dysembryoplastic neuroepithelial tumor (DNET) (4M, 6F; 7 temporal; mean age at surgery: 22.5). Eight patients (80 %) were seizure free (Class I) at the first year after surgery. At the time of last follow-up (mean 5.2 years) 7 patients (70 %, including all extratemporal cases) were Class I and 4 of them were free of medication. Twelve patients had focal cortical dysplasia (FCD) (6M, 6F; 8 temporal; mean age at surgery: 25.2). At the first postoperative year 11 patients (92 %) were Class I and at the time of last follow-up (mean 3.1 years) 2 more patients reported seizure recurrence (75 % Class I). All patients in this group are still on medication. Two patients had polymicrogyria (2M; 1 frontal, 1 occipital; mean age at surgery 24). Both are on medication due to recurrent seizures (mean follow up 8.5 years). Considerable number of patients with MCD may benefit from RES. However prognosis seems to depend on both the pathological characteristics of the MCD itself and the the duration of follow-up. Overall patients with DNET tend to have a smaller relapse rate compared to FCD after the first postoperative year.