Stereoelectroencephalography and surgical outcome in polymicrogyria-related epilepsy: A multicentric study
Language English Country United States Media print-electronic
Document type Journal Article, Multicenter Study
PubMed
29059488
DOI
10.1002/ana.25081
Knihovny.cz E-resources
- MeSH
- Child MeSH
- Adult MeSH
- Electroencephalography methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Brain physiopathology MeSH
- Polymicrogyria complications physiopathology MeSH
- Child, Preschool MeSH
- Drug Resistant Epilepsy complications physiopathology surgery MeSH
- Retrospective Studies MeSH
- Treatment Outcome MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
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.
Aix Marseille University Institute of Systems Neuroscience Marseille France
AP HM Hospital de la Timone Department of Clinical Neurophysiology Marseille France
Child Neurology University Children's Hospital Zurich Switzerland
Claudio Munari Epilepsy Surgery Centre Niguarda Hospital Milan Italy
Department of Neurology Carol Davila University of Medicine and Pharmacy Bucharest Romania
Department of Neurology Central University Hospital Grenoble France
Department of Neurology Central University Hospital Nancy Nancy France
Department of Neurology University Emergency Hospital Bucharest Romania
Department of Neurosurgery Sainte Anne Hospital Paris France
Epilepsy Unit Lille University Medical Centre Lille France
Functional Neurology and Epileptology Department Pierre Wertheimer Neurological Hospital Lyon France
INSERM U1171 University of Lille France
INSERM U1216 Grenoble Neuroscience Institute Grenoble France
Medical Faculty University of Lorraine Nancy France
Montreal Neurological Institute and Hospital McGill University Montreal Québec Canada
Neurology Department CHU Rennes France
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