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Stereoelectroencephalography and surgical outcome in polymicrogyria-related epilepsy: A multicentric study

LG. Maillard, L. Tassi, F. Bartolomei, H. Catenoix, F. Dubeau, W. Szurhaj, P. Kahane, A. Nica, P. Marusic, I. Mindruta, F. Chassoux, G. Ramantani,

. 2017 ; 82 (5) : 781-794. [pub] 20171111

Language English Country United States

Document type Journal Article, Multicenter Study

Persistent link   https://www.medvik.cz/link/bmc18016267

OBJECTIVE: We aimed to (1) assess the concordance between various polymicrogyria (PMG) types and the associated epileptogenic zone (EZ), as defined by stereoelectroencephalography (SEEG), and (2) determine the postsurgical seizure outcome in PMG-related drug-resistant epilepsy. METHODS: We retrospectively analyzed 58 cases: 49 had SEEG and 39 corticectomy or hemispherotomy. RESULTS: Mean age at SEEG or surgery was 28.3 years (range, 2-50). PMG was bilateral in 9 (16%) patients and unilateral in 49, including 17 (29%) unilobar, 12 (21%) multilobar, 15 (26%) perisylvian, and only 5 (9%) hemispheric. Twenty-eight (48%) patients additionally had schizencephaly, heterotopia, or focal cortical dysplasia. The SEEG-determined EZ was fully concordant with the PMG in only 8 (16%) cases, partially concordant in 74%, and discordant in 10%. The EZ included remote cortical areas in 21 (43%) cases and was primarily localized in those in 5 (10%), all related to the mesial temporal structures. All but 1 PMG patient with corticectomy or hemispherotomy had a unilateral PMG. At last follow-up (mean, 4.6 years; range, 1-16), 28 (72%) patients remained seizure free. Shorter epilepsy duration to surgery was an independent predictor of seizure freedom. INTERPRETATION: PMG-related drug-resistant epilepsy warrants a comprehensive presurgical evaluation, including SEEG investigations in most cases, given that the EZ may only partially overlap with the PMG or include solely remote cortical areas. Seizure freedom is feasible in a large proportion of patients. PMG extent should not deter from exploring the possibility of epilepsy surgery. Our data support the early consideration of epilepsy surgery in this patient group. Ann Neurol 2017;82:781-794.

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$a Maillard, Louis Georges $u Research Center for Automatic Control of Nancy (CRAN), University of Lorraine, CNRS, UMR 7039, Vandoeuvre, France. Department of Neurology, Central University Hospital (CHU) Nancy, Nancy, France. Medical Faculty, University of Lorraine, Nancy, France.
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$a Stereoelectroencephalography and surgical outcome in polymicrogyria-related epilepsy: A multicentric study / $c LG. Maillard, L. Tassi, F. Bartolomei, H. Catenoix, F. Dubeau, W. Szurhaj, P. Kahane, A. Nica, P. Marusic, I. Mindruta, F. Chassoux, G. Ramantani,
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$a OBJECTIVE: We aimed to (1) assess the concordance between various polymicrogyria (PMG) types and the associated epileptogenic zone (EZ), as defined by stereoelectroencephalography (SEEG), and (2) determine the postsurgical seizure outcome in PMG-related drug-resistant epilepsy. METHODS: We retrospectively analyzed 58 cases: 49 had SEEG and 39 corticectomy or hemispherotomy. RESULTS: Mean age at SEEG or surgery was 28.3 years (range, 2-50). PMG was bilateral in 9 (16%) patients and unilateral in 49, including 17 (29%) unilobar, 12 (21%) multilobar, 15 (26%) perisylvian, and only 5 (9%) hemispheric. Twenty-eight (48%) patients additionally had schizencephaly, heterotopia, or focal cortical dysplasia. The SEEG-determined EZ was fully concordant with the PMG in only 8 (16%) cases, partially concordant in 74%, and discordant in 10%. The EZ included remote cortical areas in 21 (43%) cases and was primarily localized in those in 5 (10%), all related to the mesial temporal structures. All but 1 PMG patient with corticectomy or hemispherotomy had a unilateral PMG. At last follow-up (mean, 4.6 years; range, 1-16), 28 (72%) patients remained seizure free. Shorter epilepsy duration to surgery was an independent predictor of seizure freedom. INTERPRETATION: PMG-related drug-resistant epilepsy warrants a comprehensive presurgical evaluation, including SEEG investigations in most cases, given that the EZ may only partially overlap with the PMG or include solely remote cortical areas. Seizure freedom is feasible in a large proportion of patients. PMG extent should not deter from exploring the possibility of epilepsy surgery. Our data support the early consideration of epilepsy surgery in this patient group. Ann Neurol 2017;82:781-794.
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$a Tassi, Laura $u "Claudio Munari" Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy.
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$a Bartolomei, Fabrice $u Aix Marseille University, Institute of Systems Neuroscience, Marseille, France. AP-HM, Hospital de la Timone, Department of Clinical Neurophysiology, Marseille, France.
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$a Catenoix, Hélène $u Functional Neurology and Epileptology Department, Pierre Wertheimer Neurological Hospital, Lyon, France.
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$a Dubeau, François $u Montreal Neurological Institute and Hospital, McGill University, Montreal, Québec, Canada.
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$a Szurhaj, William $u Epilepsy Unit, Lille University Medical Centre, Lille, France. INSERM U1171, University of Lille, France.
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$a Marusic, Petr $u Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic.
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$a Ramantani, Georgia $u Research Center for Automatic Control of Nancy (CRAN), University of Lorraine, CNRS, UMR 7039, Vandoeuvre, France. Child Neurology, University Children's Hospital, Zurich, Switzerland. Swiss Epilepsy Center, Zurich, Switzerland.
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