Predictor analysis of surgical outcome of drug refractory epilepsy caused by FCD

Abstract

Objective To analyze different variables in relation to seizure outcome and to identify prognostic factors for selection of patients with focal cortical dysplasia (FCD) undergoing epilepsy surgery. Methods We retrospectively analyzed the data of 43 pharmacoresistant epilepsy patients with histologically proven FCD who were admitted to Epilepsy Center, Beijing Fengtai Hospital, Medical Alliance of Beijing Tiantan Hospital, Capital Medical University from June 2011 to April 2013. Clinical data included seizure semiology, video electroencephalography findings, PET-CT and MRI findings, location of lesion, extent of resection, and pathological classification. The patients were divided into favorable group (EngelⅠ) and unfavorable group (EngelⅡ-Ⅳ) according to postoperative seizure outcome. The univariate and multivariate logistic regression were used to identify predictors of post-operative seizure freedom. Results Univariate analysis showed that patients with partial seizure onset, positive PET findings, temporal lobe FCD and completeness of resection would have a favorable seizure outcome (all P<0.05). The only significant predictor of surgical success was completeness of surgical resection by multivariate Logistic regression analysis (OR=6.857, 95%CI: 1.583-29.707, P=0.010). Conclusions The extent of lesion resection is significantly associated with post-operative seizure outcome in epilepsy patients with FCD. The seizure semiology, PET-CT and FCD location might be important factors for surgical outcomes as well. Key words: Epilepsy; Neurosurgical procedures; Prognosis; Focal cortical dysplasia; Prognostic factors