Epileptic Patient with Mild Malformation of Cortical Development with Oligodendroglial Hyperplasia and Epilepsy (MOGHE): A Case Report and Review of the Literature.

A Verentzioti,A Siatouni,S Korfias,P Patrikelis,A Alexoudi,D Sakas,I Blumcke,S Gatzonis

doi:10.1155/2019/9130780

Abstract

Introduction There is an emerging interest in the literature about MOGHE (Mild Malformation of Cortical Development with Oligodendroglial Hyperplasia and Epilepsy). We report the case of an epileptic patient with MOGHE. Case Report A 33-year-old male patient was suffering from refractory focal epilepsy since adolescence. MRI demonstrated increased T2/FLAIR signal intensity of right frontal lobe. Presurgical evaluation led to definition of epileptogenic network in a specific area of right frontal lobe. The resected specimen revealed MOGHE. Discussion. MOGHE appears to be a brain entity which shares some unique histopathological features. Review of the literature is in accordance with our patient's findings. The major neuropathological finding consists of areas with blurred gray-white matter boundaries due to heterotopic neurons in white matter and increased numbers of subcortical oligodendroglial cells with increased proliferation. MR abnormalities are present in T2/FLAIR sequences. It concerns patients with refractory frontal lobe epilepsy and appears to associate with unfavourable postsurgical outcome in seizure control. Conclusion More cases are needed in order to establish more data about this distinct entity in frontal lobe epilepsy. This could be valuable knowledge to patients and doctors concerning expectations or management of undesirable outcome in frontal lobe epilepsy surgery.

Highlights

There is an emerging interest in the literature about MOGHE (Mild Malformation of Cortical Development with Oligodendroglial Hyperplasia and Epilepsy)
We report the case of an epileptic patient with refractory epilepsy, who underwent surgical resection and had MOGHE
The absence of heterotopic neurons in deep white matter excludes its histopathological classification as mild malformation of cortical development (MCD) Palmini Type II [3]

Summary

Introduction

According to the updated classification for malformations of cortical development, there are three main categories of malformations which include the majority of histopathological findings and characteristics [1]. A percentage of 2-26% of epilepsy surgery specimens are histopathologically classified as nonlesional [2]. There is an developing interest in the international literature on MOGHE (Mild Malformation of Cortical Development with Oligodendroglial Hyperplasia and Epilepsy). It is a new histopathological entity of brain lesions which cannot be included within the existent classification. We report the case of an epileptic patient with refractory epilepsy, who underwent surgical resection and had MOGHE

Case Presentation

Discussion

Findings

Conclusion