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Pediatric Children with Minor Cortical Abnormalities Undergo Epilepsy Surgery
Hye Eun Kwon
Purpose: The observation of mild contortion of cortical development (mMCD) has yet to have a major clinical impact due to the lack of clinical and exploration data. We characterized the clinical features, surgical issues, and postoperative seizure control patterns in pediatric cases with mMCD.
Methods: We examined 40 cases with insulated mMCD who passed resective surgery during a 10- time period.
Results: The median age at seizure onset was1.2 times, and the median age at surgery was7.9 times. Twentyseven cases (67.5) presented with nonage- onset epileptic encephalopathy (21 Lennox- Gas taut pattern, 6 West pattern), and 13 cases (32.5) presented with intractable focal epilepsy (10 extra temporal lesions, 3 temporal lesions). Twenty- one cases (52.5) showed “suspected focal cortical contortion” on MRI, whereas 16 cases (40.0) and 3 cases (7.5) showed normal MRI findings or mild brain atrophy, independently. The most common surgical procedures were two lobar resections (18 cases, 45.0), followed by unilobar resections (12 cases, 30.0) and resections exceeding two lobar boundaries (10 cases, 25.0). As a final surgical outgrowth, 24 cases (60.0) were ILAE Class 1 −3. Termination of all AEDs was possible for36.8 of ILAE Class 1 cases. Regarding the seizure control pattern, shifting seizure control was observed most constantly (21 cases, 52.5).
Conclusion: Our results suggest that mMCD is an important pathological finding in children related to a significant degree of epileptogenicity, and resective surgery can have positive issues. Still, these cases showed unstable postoperative seizure control patterns with a high rate of late rush, suggesting difficulties in the surgical treatment of intractable epilepsy [1].