Abstracts

RATIONALE: Cortical developmental abnormalities (CDA) are a challenge in the treatment of epilepsies. This study addresses the seizure outcome of surgically treated patients (pts) with these abnormalities and medically intractable epilepsy (MIE). METHODS: We analyzed 25 pts with MIE secondary to CDA, and submitted to surgical treatment at the Epilepsy Surgery Center of the University Hospital (CIREP). Clinical data, structural (MRI) and functional (SPECT) neuroimaging, intraoperative ECoG, neuropathology, and seizure control were analyzed. Surgical outcome was correlated with the type and extension of the resection (complete or incomplete, as defined by postoperative MRI). RESULTS: Thirteen pts were submitted to lobectomies (7 pts with complete and 6 pts with incomplete resection). Focal (lesion) resection was performed in 10 pts (3 pts with complete and 7 pts with incomplete surgical approach). Functional hemispherectomy was performed in 2 pts. Engel classification for these patients was: 60% in class I, 24% in class II, 8% in class III, and 8% in class IV. Reoperation was performed in 2 pts classified as Engel class II. From 13 pts with imcomplete resection, 5 had Engel class I (38,5%), 4 pts showed class II (30,5%), 2 pts class III (15,5%), and 2 pts class IV (15,5%) seizure outcome. CONCLUSIONS: Best surgical outcome was reached when the lesion was more localized and the resection complete, as seen in postoperative MRI. However, patients with incomplete resection may still evolve with good seizure control.