Cases Of Drug-resistant Epilepsy Research Articles

Incomplete resection of the intracranial electroencephalographic seizure onset zone is not associated with postsurgical outcomes.

Delineation of seizure onset regions using intracranial electroencephalography (icEEG) is vital in the surgical workup of drug-resistant epilepsy cases. However, it is unknown whether the complete resection of these regions is necessary for seizure freedom, or whether postsurgical seizure recurrence can be attributed to the incomplete removal of seizure onset regions. To address this gap, we retrospectively analyzed icEEG recordings from 63 subjects, identifying seizure onset regions visually and algorithmically. We assessed onset region resection and correlated this with postsurgical seizure control. The majority of subjects had more than half of their onset regions resected (82.46% and 80.65% of subjects using visual and algorithmic methods, respectively). There was no association between the proportion of the seizure onset zone (SOZ) that was subsequently resected and better surgical outcomes (area under the receiver operating characteristic curve [AUC] < .7). Investigating the spatial extent of onset regions, we found no substantial evidence of an association with postsurgical seizure control (all AUC < .7). Although seizure onset regions are typically resected completely or in large part, incomplete resection is not associated with worse postsurgical outcomes. We conclude that postsurgical seizure recurrence cannot be attributed to an incomplete resection of the icEEG SOZ alone. Other network mechanisms beyond icEEG seizure onset likely contribute.

Seizure freedom without seizure medication following stereoelectroencephalography implantation: a case report of drug-resistant post-traumatic epilepsy.

Achieving seizure freedom following failure of several antiseizure medications (ASMs) is rare, with the likelihood of achieving further control decreasing with each successive ASM trial. When cases of drug-resistant epilepsy arise, a diagnostic procedure known as stereoelectroencephalography (sEEG) can be used to identify epileptogenic zones (EZ) within the brain. After localization of these zones, they can be targeted for future surgical intervention. Here, we describe a case of complete seizure freedom off medication after sEEG without resection or other therapeutic intervention. In 2017, a 36-year-old right-handed male presented with drug-resistant epilepsy stemming from prior traumatic brain injury. Due to ongoing seizures, in 2020 a robotic-assisted sEEG electrode placement procedure was employed to localize the seizure onset zone. During sEEG monitoring, a single event was captured where the patient had dysarthric speech, left arm dystonic flexion, and difficulty responding to questioning. Notably, this event had no sEEG correlate, suggesting seizure occurrence in a region not monitored by implanted electrodes, which prompted the placement of scalp electrodes following this event. However, no further clinical events consistent with seizure were provoked through the remainder of recording. Following the 13-day admission, the patient chose to self-discontinue all seizure medications and has remained seizure free as of October 2023, more than 3.5 years later. While sEEG is considered a relatively safe procedure for seizure localization in drug resistant epilepsy, the possibility of microlesions created by sEEG depth electrodes remains largely unexplored. Further evaluation should be performed into potential tissue injury produced by depth electrode insertion.

Etiological analysis of 167 cases of drug-resistant epilepsy in children

BackgroundTo analyze the etiological distribution characteristics of drug-resistant epilepsy (DRE) in children, with the aim of providing valuable perspectives to enhance clinical practice.MethodsIn this retrospective study, clinical data were collected on 167 children with DRE who were hospitalized between January 2020 and December 2022, including gender, age of onset, seizure types, video electroencephalogram(VEEG) recordings, neuroimaging, and genetic testing results. Based on the etiology of epilepsy, the enrolled children were categorized into different groups. The rank-sum test was conducted to compare the age of onset for different etiologies.ResultsOf the 167 cases, 89 (53.3%) had a clear etiology. Among them, structural factors account for 23.4%, genetic factors for 19.2%, multiple factors for 7.2%, and immunological factors for 3.6%. The age of onset was significantly earlier in children with genetic causes than those with structural (P < 0.001) or immunological (P = 0.001) causes.ConclusionsMore than half of children with DRE have a distinct underlying cause, predominantly attributed to structural factors, followed by genetic factors. Genetic etiology primarily manifests at an early age, especially among children aged less than one year. This underscores the need for proactive enhancements in genetic testing to unveil the underlying causes and subsequently guide treatment protocols.

Inflammation and oxidative stress in epileptic children: from molecular mechanisms to clinical application of ketogenic diet.

Childhood epilepsy affects up to 1 % of children. It has been shown that 30 % of patients are resistant to drug treatments, making further investigation of other potential treatment strategies necessary. One such approach is the ketogenic diet (KD) showing promising results and potential benefits beyond the use of current antiepileptic drugs. This study aims to investigate the effects of KD on inflammation and oxidative stress, as one of the main suggested mechanisms of neuroprotection, in children with epilepsy. This narrative review was conducted using the Medline and Google Scholar databases, and by searching epilepsy, drug-resistant epilepsy, child, children, ketogenic, ketogenic diet, diet, ketogenic, keto, ketone bodies (BHB), PUFA, gut microbiota, inflammation, inflammation mediators, neurogenic inflammation, neuroinflammation, inflammatory marker, adenosine modulation, mitochondrial function, MTOR pathway, Nrf2 pathway, mitochondrial dysfunction, PPARɣ, oxidative stress, ROS/RNS, and stress oxidative as keywords. Compelling evidence underscores inflammation and oxidative stress as pivotal factors in epilepsy, even in cases with genetic origins. The ketogenic diet effectively addresses these factors by reducing ROS and RNS, enhancing antioxidant defenses, improving mitochondrial function, and regulating inflammatory genes. Additionally, KD curbs pro-inflammatory cytokine and chemokine production by dampening NF-κB activation, inhibiting the NLRP3 inflammasome, increasing brain adenosine levels, mTOR pathway inhibition, upregulating PPARɣ expression, and promoting a healthy gut microbiota while emphasizing the consumption of healthy fats. KD could be considered a promising therapeutic intervention in patients with epilepsy particularly in drug-resistant epilepsy cases, due to its targeted approach addressing oxidative stress and inflammatory mechanisms.

IEEG-recon: A fast and scalable pipeline for accurate reconstruction of intracranial electrodes and implantable devices.

Clinicians use intracranial electroencephalography (iEEG) in conjunction with noninvasive brain imaging to identify epileptic networks and target therapy for drug-resistant epilepsy cases. Our goal was to promote ongoing and future collaboration by automating the process of "electrode reconstruction," which involves the labeling, registration, and assignment of iEEG electrode coordinates on neuroimaging. We developed a standalone, modular pipeline that performs electrode reconstruction. We demonstrate our tool's compatibility with clinical and research workflows and its scalability on cloud platforms. We created iEEG-recon, a scalable electrode reconstruction pipeline for semiautomatic iEEG annotation, rapid image registration, and electrode assignment on brain magnetic resonance imaging (MRI). Its modular architecture includes a clinical module for electrode labeling and localization, and a research module for automated data processing and electrode contact assignment. To ensure accessibility for users with limited programming and imaging expertise, we packaged iEEG-recon in a containerized format that allows integration into clinical workflows. We propose a cloud-based implementation of iEEG-recon and test our pipeline on data from 132 patients at two epilepsy centers using retrospective and prospective cohorts. We used iEEG-recon to accurately reconstruct electrodes in both electrocorticography and stereoelectroencephalography cases with a 30-min running time per case (including semiautomatic electrode labeling and reconstruction). iEEG-recon generates quality assurance reports and visualizations to support epilepsy surgery discussions. Reconstruction outputs from the clinical module were radiologically validated through pre- and postimplant T1-MRI visual inspections. We also found that our use of ANTsPyNet deep learning-based brain segmentation for electrode classification was consistent with the widely used FreeSurfer segmentations. iEEG-recon is a robust pipeline for automating reconstruction of iEEG electrodes and implantable devices on brain MRI, promoting fast data analysis and integration into clinical workflows. iEEG-recon's accuracy, speed, and compatibility with cloud platforms make it a useful resource for epilepsy centers worldwide.

A case of drug-resistant epilepsy and autism with de novo SLC6A8 gene variant

A case of drug-resistant epilepsy and autism with de novo SLC6A8 gene variant

NMDA, AMPA and GABA Receptor Antibodies: Relation to Clinical and Electrophysiological Findings in Drug-Resistant Epilepsy

Abstract Background Epilepsy is a neurological disorder characterized by sudden recurrent episodes of convulsions, sensory disturbance, or loss of consciousness, resulting from abnormal electrical brain activity. It can have both genetic and acquired causes, with interaction of these factors in many cases. Auto-antibodies against synaptic receptors have been detected in a number of neurological conditions such as anti-NMDA receptor encephalitis and limbic encephalitis. Recently, three types of synaptic receptors have been the subject of research as regarding their role in the normal physiology of the nervous system, and their involvement in various neurological conditions. These receptors include AMPA receptors, NMDA receptors and GABAB receptors. Antibodies directed against these receptors may be the underlying cause of many cases of drug resistant epilepsy. Objectives To determine the prescence of autoantibodies against AMPA, NMDA and GABAB receptors in drug-resistant epilepsy and their correlation with clinical and electrophysiological findings. Methods The study was conducted on 17 epilepsy patients (12 males and 5 females) who were sampled for both CSF and blood. All CSF and serum samples were examined by the Indirect Immunofluorescence cell based technique for the detection of AntiAMPAR, Anti-NMDAR and Anti-GABAB antibodies. Results Only one case tested positive for Anti-NMDAR antibodies in CSF, while all other serum and CSF samples were negative for other antibodies. These results are still in process since our data will be used in a further study related to auto-immune drug-resistant epilepsy patients involving other auto-antibodies such as Ant-LGI1, Anti-CASPR2 and Anti-DPPX antibodies. Conclusion Testing Anti-NMDAR antibodies can be promising in detecteing drug resistant epilepsy patients even after receiving immunomodulatory treatment protocols.

Clinical importance of peri-ictal water drinking

BackgroundPeri-ictal water drinking is drinking water within a short period or during a seizure. This behavior can be experienced in childhood and adulthood and commonly affects adults suffering from temporal lobe epilepsy. Peri-ictal water drinking has clinical importance for lateralizing signs in the non-dominant hemisphere. It has been found in up to 7–15% of patients with focal epilepsy.Case presentationThis case study involved a 44-year-old right-handed female referred tour center as a case of drug-resistant epilepsy for presurgical evaluation. After evaluation in the Epilepsy Monitoring Unit, the patient was considered a candidate for right temporal lobectomy. The patient exhibited good outcome post-temporal lobectomy.ConclusionsThis case highlights the previously observed association between peri-ictal water drinking and the non-dominant hemisphere in patients with epilepsy. Clinicians must not overlook this automatic behavior that both patients and physicians usually underestimate because drinking water is a normal phenomenon.

SHORT-TERM SURGICAL OUTCOMES IN PATIENTS WITH DRUG-RESISTANT EPILEPSY DUE TO LESIONAL TEMPORA

Objectives: To describe the outcome of 35 cases of drug-resistant epilepsy due to the lesional temporal lobe surgery at Vietduc University Hospital from May 2018 to September 2022. Methods: A prospective description combined with retrospective, longitudinal follow-up of all patients diagnosed with drug resistance due to lesional temporal lobe epilepsy undergoing surgery at Vietduc University Hospital was conducted. Results: 35 cases of intractable lesional temporal lobe epilepsy surgery, male/female 1.5/1, partial seizures with loss of consciousness accounted for 99%, and 2/3 of cases occurred without aura. Seizure-free (post-operation 1 month) (Engel I) accounted for 74.3%, and the remaining (25.7%) had improved seizures (Engel 2, 3). Complications after surgery accounted for 17.1%, and there were no cases of death. Conclusion: Surgical treatment for drug resistance due to lesional temporal lobe epilepsy is safe and very effective, with a low complication rate.

210 Intra-Operative Electrocorticography (ECoG) for Lesional Epilepsy: A Randomized Controlled Trial (IO-ECoG Trial)

INTRODUCTION: Usage of Electrocorticography (ECoG) is not clearly established. Robust evidence doesnot exist to support its regular usage in Long term Epilepsy associated tumors (LEATs) which constitutes approximately 25-35% cases of drug resistant epilepsy. METHODS: Prospective randomized controlled trial, including all patients operated for drug resistant epilepsy with non-eloquent area LEATs. Patients were randomized into 2 groups namely Group I (without usage of ECoG) and Group II (with ECoG usage). Group II patients further underwent tailored resections if necessary, as per ECoG practice protocols. Surgical outcomes were evaluated for seizure outcome (Engel scale) and adverse event profile. RESULTS: Total of 38 patients operated for LEATs having drug resistant epilepsy were included in the study with mean age of 21.1 years (range 2-46 years). 18 patients belonged to Group I and 20 patients belonged to Group II with mean follow-up period of 11.02 months (range 3-22 months). 30% patients (n = 6) in Group II underwent extended resection based on rhythmic persistent post resection spikes. 90% of Group II patients had Engel score Ia during follow up compared to 77.7% of Group I with Engel score Ia (p = 0.302). In Group II, 85.7% patients with extended tailored resection had Engel score Ia compared to 83.8% cases without extended resection (p = 0.904). CONCLUSIONS: Though ECoGs role may have been established in focal cortical dysplasia, its utility in LEATs is limited. Our randomized study confirmed that there is no added benefit conferred by the use of ECoG in LEATS. Additional tailored resections aided by ECoG also did not yield seizure outcome benefits in LEATS.

ID:16045 Simultaneous Deep Brain Stimulation and Responsive Neurostimulation for Drug Refractory Epilepsy: A Case Report Study

Nearly 25% of all epilepsy is Drug Resistant Epilepsy (DRE) 1-3. Surgical evaluation should be considered early in the course of the disease to minimize morbidity and the risk of sudden unexpected death in epilepsy (SUDEP)4-5. Neuromodulation is a viable option when resection or ablation is not feasible. A growing body of evidence shows improved seizure control and long-term efficacy with both7. With highly complex epileptogenic networks, a multimodality approach may provide an additional benefit to maximize seizure control. We report two cases of DRE who underwent anterior nucleus of the thalamus (ANT) DBS implantation followed by RNS implantation. To our knowledge, this is the first report of simultaneous DBS and RNS neurostimulation for the treatment of epilepsy.

Non-invasive, neurotoxic surgery reduces seizures in a rat model of temporal lobe epilepsy

Surgery can be highly effective for treating certain cases of drug resistant epilepsy. The current study tested a novel, non-invasive, surgical strategy for treating seizures in a rat model of temporal lobe epilepsy. The surgical approach uses magnetic resonance-guided, low-intensity focused ultrasound (MRgFUS) in combination with intravenous microbubbles to open the blood-brain barrier (BBB) in a transient and focal manner. During the period of BBB opening, a systemically administered neurotoxin (Quinolinic Acid: QA) that is normally impermeable to the BBB gains access to a targeted area in the brain, destroying neurons where the BBB has been opened. This strategy is termed Precise Intracerebral Non-invasive Guided Surgery (PING). Spontaneous recurrent seizures induced by pilocarpine were monitored behaviorally prior to and after PING or under control conditions. Seizure frequency in untreated animals or animals treated with MRgFUS without QA exhibited expected seizure rate fluctuations frequencies between the monitoring periods. In contrast, animals treated with PING targeting the intermediate-temporal aspect of the hippocampus exhibited substantial reductions in seizure frequency, with convulsive seizures being eliminated entirely in two animals. These findings suggest that PING could provide a useful alternative to invasive surgical interventions for treating drug resistant epilepsy, and perhaps for treating other neurological disorders in which aberrant neural circuitries play a role.

The Role of Magnetoencephalography and Single-Photon Emission Computed Tomography in Evaluation of Children With Drug-Resistant Epilepsy

Surgery holds the best outcomes for drug-resistant epilepsy in children, making localization of a seizure focus essential. However, there is limited research on the contribution of magnetoencephalography and single-photon emission computed tomography (SPECT) to the presurgical evaluation of lesional and nonlesional pediatric patients. This study proposed to evaluate the concordance of SPECT and magnetoencephalography (MEG) to scalp electroencephalography (EEG) to determine their effective contribution to the presurgical evaluation. On review, MEG and SPECT studies for 28 drug-resistant epilepsy cases were completed at Children's Hospital of Pittsburgh from May 2012 to August 2018. Although not reaching statistical significance, MEG had increased lobar concordance with EEG compared with SPECT (68% vs 46%). MEG or SPECT results effectively provided localization data leading to 6 surgical evaluations and 3 resections with outcomes of Engel class I or II at 12 months. This study suggests MEG and SPECT provide valuable localizing information for presurgical epilepsy evaluation of children with drug-resistant epilepsy.

A Case of Drug-resistant Epilepsy Associated with Ring Chromosome 20.

A Case of Drug-resistant Epilepsy Associated with Ring Chromosome 20.

Factors influencing the long-term prognosis of patients with temporal lobe epilepsy: a single center study.

This study aimed to explore the risk factors influencing the long-term prognosis of temporal lobe epilepsy (TLE) patients treated with drug therapy or surgical treatment. A total of 112 patients who were diagnosed with TLE were retrospectively enrolled. All of the patients were initially treated with antiepileptic drugs (AEDs). Patients who met the criteria of drugresistant TLE were evaluated for treatment with temporal lobectomy. The main outcome was whether the patients achieved seizure-free status. This was defined as when a patient experienced no seizures for at least 24 months of follow-up. The independent predictors of the outcome were evaluated using a multiple logistic regression model. The median follow-up period was 5 years (range, 2-13 years). At the end of follow-up, 26 patients had not achieved seizure freedom after treatment with AEDs, including 22 cases of monotherapy, 4 cases of duotherapy (1 case of drug-resistant epilepsy after continuous drug treatment). AED treatment was withdrawn in 6 patients. Overall, 23.2% TLE patients (26/112) achieved seizure freedom after treatment with AEDs alone, while the remaining 76.8% (86/112) of patients were diagnosed as drug-resistant epilepsy (DRE). Of the 45 DRE patients who subsequently received surgical treatment, 77.8% (35/45) achieved seizure freedom, with successful AED withdrawal in 11 patients. The proportion of patients who achieved seizure-free status was higher among those who underwent temporal lobectomy than among those who continued with AED treatment (77.8% vs. 23.2%, P<0.001). Effective early monotherapy was an independent predictor for good therapeutic effect in all TLE patients (OR: 0.16; 95% CI: 0.04-0.66; P=0.007). Multivariate logistic regression analysis showed the predictors of good prognosis in DRE patients after surgery to be unilateral origin of discharges in electroencephalogram (EEG, OR =0.20, 95% CI: 0.06-0.74, P=0.016), no secondary generalized tonic-clonic seizures (GTCS, OR =0.08, 95% CI: 0.01-0.67, P=0.002), and not needing a subdural electrode (OR =15.4, 95% CI: 1.36-174.38, P=0.027). Effective early monotherapy was an independent protective factor for the favorable prognosis of TLE. Unilateral origin of discharges in EEG, no secondary GTCS, and not needing a subdural electrode were independent factors associated with favorable prognosis after TLE surgery.

Anti-Hu-related epilepsy diagnosed after surgical management.

Autoimmune epilepsy (AE) refers to epilepsy mediated by autoantibodies or immune cells, and a large proportion of drug-resistant epilepsy cases are classified as AE. AE lacks standardized management guidelines. At present, little research has been conducted on the effectiveness of surgical treatment of AE. This paper reports a patient whose surgical treatment was ineffective before AE was diagnosed and who improved after immunotherapy. A literature review was conducted to examine the progress of surgical treatment of epilepsy, the relationship of temporal lobe epilepsy to neuronal antibodies, surgical and prognostic factors, research progress on the anti-Hu antibody, and treatment of autoimmune encephalitis to provide a clinical reference.

Drug Resistant Epilepsy Among Patients Attended The Neurosciences Hospital

Background: Drug resistant epilepsy is defined as failure of adequate trials of two tolerated, appropriately chosen and used antiepileptic drug schedules to achieve sustained seizure freedom. Up to 30% of patients referred to clinics with a diagnosis of pharmaco-resistant epilepsy may have been misdiagnosed, and many can be helped by optimizing their treatment.Pseudoresistance, in which seizures persist because the underlying disorder has not been adequately or appropriately treated, must be ruled out or corrected before drug treatment can be considered to have failed.&#x0D; Objectives: The objectives of this study were to determine the causes of drug failure in patients with epilepsy and to differentiate between drug resistant epilepsy and pseudoresistant epilepsy.&#x0D; Type of the study: This is a retrospective study.&#x0D; Method: It is conducted in Baghdad governorate at the epilepsy clinic in the neurosciences hospital during the period from the 1st of February through July 2013. Two hundred patients with refractory epilepsy were involved. These patients attended the epilepsy clinic during 2011 and 2012. The data was collected from the files of the patients including age, gender, weight, history of presenting illness, type of seizure, drugs used, duration of disease, EEG and imaging findings, compliance and follow up.&#x0D; Results: Drug resistance epilepsy constituted a prevalence of 24% (128) as the total number of patients with epilepsy attending the hospital during the same period was 527.The mean age of patients with refractory epilepsy was 25 years. Male were 56.5% (113/200) and urban residents were 70.5% (141/200). The study revealed that 64% (128/200) of refractory epilepsy was attributed to drug resistance; while the remaining proportion was pseudoresistance 36% (72/200). The main cause of pseudoresistance was poor compliance 36.1% (26/72).The most common type of seizure in the sampled patients was generalized tonic clonic seizures in 51.5% (103/200).Compliance was found to be statistically associated with abnormal EEG finding, past medical history (hypertension, cardiac diseases, encephalitis, diabetes mellitus and any significant history) and quality of follow up. The follow-up was found to be statistically associated with the family history, past medical history( encephalitis and hypertension) and compliance of patient.&#x0D; Conclusion:A considerable number of patientsdiagnosed as cases of drug resistant epilepsy had another explanation causing drug failure.The study recommends the application of consensus definition for drug resistant epilepsy and periodic evaluation of patients with drug resistant epilepsy to exclude pseudoresistance.

Brain microstructural abnormalities correlate with KCC2 downregulation in refractory epilepsy.

Dysregulations in the expression level of Na-K-Cl cotransporter (NKCC1) and K-Cl cotransporter (KCC2) genes have been detected in the brain tissues of patients with refractory epilepsy. Given the importance of these proteins in the determination of Cl equilibrium potential (ECl), evaluation of the expression changes of these transporters might assist in optimizing the diagnostic approaches and therapeutic strategies. The present investigation evaluates the expression level chloride transporters in polymorphonuclear cells and their correlation with microstructural abnormalities. Thirty cases of drug-resistant epilepsy (confirmed with temporal lobe epilepsy diagnosis) fulfilled the considered inclusion criteria. Cases were divided into two groups, one with a detectable MRI lesion (19 participants; right side) and another with no MRI findings (11 participants). Whole-brain voxel-based analysis was performed on diffusion tensor imaging to measure fractional anisotropy and mean diffusivity; neurite orientation dispersion and density imaging was performed to map neurite density index and orientation dispersion index. Our results indicated that fractional anisotropy and mean diffusivity changed in temporal and extratemporal parts of the brain, whereas the changes in neurite density index and orientation dispersion index were exclusively obvious in the temporal lobe. Molecular studies revealed significantly lower levels of KCC2 expression in patients with epilepsy, a finding that remarkably correlated with microstructural changes as well. Our research showed that downregulation of KCC2 and microstructural abnormalities might contribute to the observed refractoriness in temporal lobe epilepsy.

The role of ABCC2 gene in drug-resistant epilepsy

Objective To investigate the role of the ATP binding box C subfamily 2 transporter protein (ABCC2) gene in drug-resistant epilepsy. Methods From February 2014 to February 2018, 204 epileptic patients were treated in our hospital, including 41 cases of drug resistance epilepsy (drug resistance group), 163 cases of non drug resistant epilepsy (sensitive group). The rs717620 polymorphism of ABCC2 gene and the level of P- glycoprotein (P-gp) in cerebrospinal fluid and serum were detected in two groups. Results The proportion of genotype TT and gene frequency T in the drug resistant group were 24.39% and 41.46%, respectively, which were significantly higher than those in the sensitive group (P 0.05); The concentration of P-gp in cerebrospinal fluid of patients with genotype TT in drug resistance group was (24.03±3.57)ng/ml, which was significantly higher than that of type CC and CT (P 0.05). Conclusions The rs717620 polymorphism of ABCC2 gene may be associated with drug-resistant epilepsy, and may be related to P-gp level in the cerebrospinal fluid. Key words: Multidrug resistance-associated proteins/GE; Polymorphism, single nucleotide; Epilepsy

Putting the new ILAE classification of focal cortical dysplasia into practice in western China

PurposeTo re-examine drug-resistant epilepsy cases using the revised 2011 ILAE classification of focal cortical dysplasia (FCD). MethodsPatients with drug-resistant epilepsy who have undergone epilepsy surgery in West China Hospital between July 2012 and Jun 2014 were included. Clinical histories, pathological diagnoses, and surgical outcomes were reviewed. A questionnaire was developed to investigate the clinical practice of the new classification. A short-term training program on FCD was carried out to improve pathological diagnosis accuracy. Results260 consecutive cases (177 male and 83 female) were included. Pathological diagnosis was changed in 70 cases (26.9%) after re-examination. The five most common pathological types were hippocampal sclerosis (19.2%, 50/260), brain tumors (17.7%, 46/260), vascular malformations (16.2%, 42/260), glial scars (11.2%, 29/260) and FCD (10.0%, 26/260). The most common subtype of isolated FCD was FCD IIb (53.8%, 14/26), followed by FCD IIa (42.3%, 11/26) and FCD Ib (3.8%, 1/26). In addition, forty-five cases were diagnosed as associated FCD type III (17.3%, 45/260). Half of patients with FCD achieved Engel class I at two-year follow-up. Questionnaire investigation suggested most participant pathologists lack sufficient knowledge on the new classification. The diagnostic sensitivity for different FCD subtypes was significantly improved by two to six folds after short-term training. ConclusionsFCD is an important etiology of drug-resistant epilepsy in western China. It is essential to provide continuing trainings to improve diagnostic precision of FCD in developing countries.