Wyniki kliniczne i czynniki ryzyka w padaczce u dzieci związanej z ogniskową dysplazją kory mózgowej: retrospektywne badanie kohortowe 628 potwierdzonych przypadków

OBJECTIVE: To investigate the clinical high-risk factors for epilepsy secondary to focal cortical dysplasia (FCD) in children and for progression to drug-resistant epilepsy, and to evaluate the long-term prognosis of affected patients. METHODS: We retrospectively included 628 children with MRI-diagnosed FCD who were treated at the Children's Hospital of Chongqing Medical University between February 2006 and September 2025. Risk factors for epilepsy and drug-resistant epilepsy were analyzed using Cox and Logistic regression models, with cluster analysis applied to define clinical subtypes and the stability of the clustering solution was verified by bootstrap resampling. RESULTS: The incidence of epilepsy in children with FCD was 79.0% (496/628), of whom 24.0% (151/628) progressed to drug-resistant epilepsy. Among the 81 surgically treated children with medium- to long-term follow-up, 72.8% (59/81) achieved complete seizure freedom. Multivariate Cox regression analysis demonstrated that global developmental delay (P=0.004), intellectual disability (P=0.002), paralysis (P=0.014), hypoplasia of the white matter (P<0.001), repetitive epileptiform discharges lasting ≥5 seconds during the interictal period (P=0.003), and continuous irregular slow waves (P=0.016) were independently associated with epilepsy onset. Multivariate Logistic regression analysis showed that the interictal RED type II waveform (P=0.003) was an independent high-risk factor for drug-resistant epilepsy. Cluster analysis classified the patients into three subtypes: a low-risk group characterized by seizure freedom or drug responsiveness, essentially normal intelligence, lesions confined to a single lobe, and no EEG abnormalities; an intermediate-risk group, also predominantly seizure-free or drug-responsive, but frequently accompanied by intellectual disability, with single-lobe lesions and a single abnormal EEG pattern; and a high-risk group dominated by drug-resistant epilepsy, often complicated by intellectual disability, with lesions frequently involving multiple lobes and multiple abnormal EEG patterns. Bootstrap validation indicated moderate stability of the clustering structure (ARI = 0.653). CONCLUSION: Children with FCD show marked clinical heterogeneity, and their prognosis is closely associated with neurodevelopmental deficits, lesion extent, and electrophysiological characteristics. Early identification of these high-risk factors, together with cluster-based stratified management, may be of substantial importance for improving patient outcomes.