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Abstracts

Long-Term Treatment Outcome of MRI-Diagnosed Focal Cortical Dysplasia in a Non-Pediatric Setting: A Retrospective Cohort Study

Abstract number : 3.216
Submission category : 4. Clinical Epilepsy / 4D. Prognosis
Year : 2023
Submission ID : 972
Source : www.aesnet.org
Presentation date : 12/4/2023 12:00:00 AM
Published date :

Authors :
Presenting Author: Woo-Seok Ha, MD – Yonsei University College of Medicine

Kimoon Jang, MD – Department of Neurology – Yonsei University College of Medicine; Soomi Cho, MD – Department of Neurology – Yonsei University College of Medicine; Kyung Min Kim, MD – Department of Neurology – Yonsei University College of Medicine; Min Kyung Chu, MD, PhD – Department of Neurology – Yonsei University College of Medicine; Kyoung Heo, MD, PhD – Department of Neurology – Yonsei University College of Medicine

Rationale: Focal cortical dysplasia (FCD) is generally known to be associated with poorer treatment outcomes than other pathologies, but there is a lack of information on treatment resistance in patients with FCD in real world clinical practice. We aimed to investigate the long-term treatment outcome of MRI-diagnosed FCD and to determine the risk factors for medication refractoriness.

Methods: We retrospectively analyzed the seizure outcomes of 128 patients (43 untreated and 85 treated including 12 with seizure-free [SF] state at the initial visit) who were diagnosed with FCD by MRI at a single center between 2000 and 2021 and followed up for at least two years. The primary outcome was > 1 year SF at the last visit. We reviewed each patient’s MRI for the presence of typical FCD findings, and identified variables associated with seizure outcome using multivariate logistic regression modeling. In subgroup analyses, seizure outcomes were investigated according to the number of antiseizure medications (ASMs) prior to the initial visit.

Results: After a mean follow-up of 9.7 years, 87 (68%) and 80 (62.5%) of 128 patients remained SF including aura only, and completely SF for > 1 year at their last visit, respectively. We identified several risk factors for poor outcome: younger age at onset (odds ratio [OR] 0.95 per +1 year, 95% CI 0.91-0.99), focal impaired awareness seizure as the first seizure type (OR 5.29, 1.81-15.43), bottom of sulcus dysplasia (OR 4.00, 1.34-11.74), and gray matter T2/FLAIR hyperintensity (OR 4.49, 1.57-12.83). There was no association between FCD locations or EEG findings and the seizure outcome (Figure 1). Compared to the treated patients, untreated patients were significantly more likely to achieve seizure freedom after adjustment for covariates (37 of 43, 86% vs. 38 of 73, 52.1%, p < 0.001), and number of ASMs prior to the initial visit increased the risk of medication refractoriness (hazard ratio [HR] 1.340 per +1 ASMs, 95% CI 1.15-1.56, p < 0.001) (Figure 2). Among the patients with
Clinical Epilepsy