Clinical characteristic and surgical outcomes of children′s epilepsy caused by rolandic focal cortical dysplasia

Abstract

Objective To investigate the clinical features, evaluation methods and value of resective surgery in children with epilepsy caused by rolandic focal cortical dysplasia (FCD). Methods Eight patients with epilepsy related to rolandic FCD were admitted to Epileptic Center, Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from May 2015 to June 2017 and enrolled into this retrospective study. All patients underwent head MRI, positron emission tomography (PET)-CT and video-EEG. Three patients underwent stereo-electroencephalography (SEEG) electrode implantation and EEG monitoring lasting for 1-7 days. According to the patient's epileptic symptoms, imaging, and scalp or intracranial EEG results, the epileptogenic zone was identiried and surgical resection was performed. All patients were followed up through outpatient visits or telephone. The Engel scale was used to evaluate the surgical outcome and the limb strength was also assessed. Results Among 8 patients, the epileptogenic zone was confined to the central area in 2 and surrounding areas of the central area in the other 6 cases, which included the operculum, secondary motor area, premotor area and insula. Postoperative pathological findings showed FCD type Ⅱ in 7 and FCD type Ⅲd in 1. Image post-processing techniques and SEEG techniques facilitated the determination of epileptogenic zone. The follow-up duration for the 8 patients was 0.3-2.5 years, with the median of 0.6 year. All patients showed epilepsy remission (Engel Ⅰ). At 1 week post surgery, 7 patients had varying degrees of decline in contralateral limb muscle strength and grade 0 was reported in the most severe case. Until the last follow-up, the limb muscle strength of 7 patients improved with varying degrees. Conclusions Children with rolandic FCD have complicated epilepsy symptoms. The prognosis could be satisfactory following resection surgery. The muscle strength might decrease during a short term post operation and gradually recover. Early surgical intervention in children with such conditions may provide more benefits. Key words: Epilepsy; Child; Follow-up studies; Prognosis; Focal cortical dysplasia