Epilepsy patients with malformations of cortical development: Experience from a tertiary care centre in Eastern India

Abstract

Malformations of cortical development (MCD) are lesions produced by insult to the developing neocortex. MCD are frequently associated with refractory epilepsy. Clinical and electrophysiologic findings of MCD are variable. Our aims in this study are to identify cases of MCD in patients having epilepsy, to study the semiology of seizure, to look for associated risk factors and to correlate the semiology of seizure with the electroencephalographic (EEG) and magnetic resonance imaging (MRI) findings. We studied 54 patients with MCD (from January 2011 till October 2012). Detailed medical and family histories were obtained in addition to neurological examinations and routine EEG evaluations. There were 29 (53.7%) males and 25 (46.3%) females, with ages ranging from 5 mo to 43 yr. The focal cortical dysplasias cases were sixteen (29.6%), schizencephaly eight (14.8%), polymicrogyria eight (14.8%), dysembryoblastic neuroepithelial tumor six (11.1%), lissencephaly five (9.3%), ganglioglioma three (5.6%), heterotopias three (5.6%), hemimegalencephaly two (3.7%), cortical hamartomas of tuberous sclerosis two (3.7%) and mixed lesion in one (1.8%). Overall, 40 (74.1%) cases had partial seizures. The EEG revealed interictal epileptiform discharges in 27 (50.0%) with the rest being normal. The commonest type of MCD was the focal cortical dysplasia. Most (74.1%) cases had focal seizures. There was poor correlation between semiology of seizure with the EEG and MRI findings. There was no history of any antenatal maternal infection or drug exposure. No risk factor except for positive family history was identified.