Ogniskowa dysplazja kory mózgowej typu II: 10 lat doświadczeń w leczeniu pacjentów z epilepsją w ośrodku referencyjnym
A cohort approach to focal cortical dysplasia type II: A 10-year management overview at an adult epilepsy referral centre
W skrócie
Badanie obejmowało 50 pacjentów z ogniskową dysplazją kory mózgowej typu II, u których epilepsja była oporna na leki. U większości pacjentów zastosowano leczenie chirurgiczne, które przyniosło dobre wyniki - około 80% pacjentów przestało mieć napady już 2 lata po operacji. Wyniki pokazują, że tego rodzaju pacjentów powinni leczyć specjaliści w wyspecjalizowanych ośrodkach, ponieważ wymaga to zaawansowanych badań obrazowych i testów funkcji mózgu.
Oryginalny abstract (angielski)
INTRODUCTION: Focal cortical dysplasia (FCD) type II, or Taylor-type FCD, is considered a common cause of drug-resistant epilepsy, with specific characteristics. In many cases, these patients respond well to surgery. PATIENTS AND METHODS: The study included patients with FCD type II who had undergone an epilepsy protocol brain MRI scan, evaluated by an expert neuroradiologist, since 2012. We performed a retrospective observational analysis of diagnostic variables, clinical correlations with presurgical evaluation studies, indications for surgery, and response. RESULTS: The sample included 50 patients (50% women, with a mean [SD] age at seizure onset of 13 [9.7] years). All patients were diagnosed with focal-onset seizures. Some 12.5% of patients also presented functional non-epileptic seizures. Seizure frequency was daily or weekly in 70% of cases, and drug-resistant epilepsy was diagnosed in 72%. FCD was most frequently located in the frontal lobes (68%). In 87% of cases, a correlation was observed between the FCD region and hypometabolism on FDG-PET. Twenty-six patients underwent surgical treatment, and two other patients are currently awaiting surgery. In the surgery group, 79% of patients were seizure-free at 2 years after the procedure. CONCLUSIONS: FCD type II is not always associated with drug-resistant epilepsy. Diagnosis does not rule out the presence of functional seizures. Because of the need for neurophysiological and protocolised neuroimaging tests, these patients should be managed at expert units within referral centres. Surgery achieves clinical improvement in most cases, with complete seizure freedom in approximately 80% of our series.