SEIZURE[acute]S OUTCOME AFTER SURGERY FOR CORTICAL DYSPLASIA IN CHILDREN
Abstract number :
1.430
Submission category :
Year :
2003
Submission ID :
1928
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Carla Baise, Cristine M. Baldauf, Meire Argentoni, Cassio R. Forster, Valeria A. Mello, Leila Frayman, Arthur Cukiert, Jose A. Burattini, Pedro P. Mariani, Joaquim O. Vieira, Rodio Brandao, Lauro Ceda Neurology and Neurosurgery, Hospital Brigadeiro, Sao P
Cortical dysplasia (CD) represents an important etiology for refractory epilepsy in the pediatric population. Early pre-MR reports suggested that surgery for CD yielded poorer results when compared to other lesionectomies. We report on a pediatric series of patients with CD diagnosed and treated during the MR era.
Fifty-one children with CD submitted to surgery were studied. Age ranged from 9 months to 16 years (m=9,6 years) and follow up time from 9 months to 7 years (m=2,9 years). All patients were submitted to high-resolution MRI and interictal EEG; none needed prolonged video-EEG recordings. Overall, twenty-five patients had focal, 22 extensive and 4 hemispheric CD. There were 20 patients with predominantly temporal lobe CD, 23 with frontal lobe and 4 with diffuse unilateral CD.
Interictal EEG was localizing in 33/51 patients. Lesionectomy was performed in 48 and hemispherectomy in 3 patients. Intraoperative ECoG was performed in 29 patients. Forty-five patients have been seizure-free and six had Engel II results since surgery.
Seizure[rsquo]s outcome after surgery targeted at CD is similar to that obtained in other lesionectomies. Since CD is rarely a circumscribed lesion, extensive resections are preferred, even in patients with apparently focal lesions (Taylor[rsquo]s type). Despite the fact that ECoG might be used to define the surgical resection margins, surgery is usually limited by vascular and functional findings and not by the ECoG results; ECoG is probably not needed in the majority of the patients.
[Supported by: Sao Paulo Secretary of Health]