Abstracts

Rationale: Epilepsy surgery for focal cortical dysplasia (FCD) often requires multiple noninvasive as well as invasive pre-surgical evaluation and innovative surgical strategies. There is limited data regarding surgical management of people with chronic drug resistant epilepsy (DRE) & FCD among the low and middle income countries (LAMIC) including India.Methods: Presurgical evaluation, surgical strategy and outcome of 53 people who underwent resective surgery for DRE with FCD between July 2007 and June 2014 were analyzed. The surgical outcome was correlated with pre-operative clinical VEEG, MRI, invasive monitoring, surgical findings as well as histopathology and QOLIE-89 scores.Results: This cohort consists of 19 cases evaluated retrospectively and 34 cases prospectively. Age of onset ranged from 3 months to 43 years (mean 9.28yrs; SD 7.25). Duration of epilepsy ranged from 1-39 years (mean 11.68; SD 8.99). The following lobar distribution was found; Temporal-31 (Language-13), Frontal-9 (Motor Cortex-5), Parietal-5 (Sensory Cortex-4), Occipital-3 and multilobar-5. Forty seven percent of the cases had FCD in the right hemisphere and 53% had FCD in the left hemisphere. Invasive monitoring was performed for identification of the epileptogenic zone (EZ) as well as eloquent cortex in 7 and intra-operative electro-corticography (ECoG) was used in 32 cases. Surgery was tailored in 29 cases based upon ECoG. Histopathology revealed the following distribution; FCD Ia-5, Ib-2, Ic-4, IIa-6, IIb-10, IIIa-20, IIIb-3, IIId-3. Overall outcome of Engel’s class Ia was 61.3 %. Pre-operative QOLIE-89 score was 26.33-40.17 (mean 33.69, SD 4.35) and post-operative score was 59.21-89.79(mean 73.81; SD 8.29; p=0.04).Conclusions: Surgical management of people with DRE and FCD is possible in countries with limited resources. Meticulous pre-surgical evaluation to localize epileptogenic zone and complete resection of the focus and lesion can lead to cure or control of epilepsy. In this study, temporal location (p = 0.02), complete resection (p < 0.001), and Type I FCD were found to be positive prognostic indicators for seizure-free outcome. Statistically significant improvement in QOL was observed along with seizure-free outcome.