Surgical treatment of epilepsy in children with focal cortical dysplasia in central gyri.

Unlabelled: Focal cortical dysplasias are known to be the most frequent and furtive lesions leading to intractable epilepsy in children. Epilepsy surgery in central gyri, been effective in 60-70% of cases, is still significantly challenging due to the high risk of postoperative permanent neurological impairment.

Study Aims: Assessment of the outcome after epilepsy surgery in children with FCD in central lobules.

Material And Methods: Nine patients, median age 3.7 ys, IQR=5.7 ys (min 1.8- max 15.7 ys) with FCD in central gyri and DR-epilepsy underwent surgery. Standard preoperative evaluation included MRI and video-EEG. Invasive recordings were used in 2 cases, coupled by fMRI in 2. An ECOG and neuronavigation, as well as stimulation and mapping of primary motor cortex were used routinely during the procedure. Gross total resection was achieved in 7 patients according to postoperative MRI.

Results And Conclusions: Six patients with new or worsening of already existing hemiparesis recovered within a year after surgery. At the last FU (med 5 ys) favorable outcome (Engel class IA) has been achieved in 6 cases (66.7%), while two patients with persisting seizures reported seizing less frequently (Engel II-III). Three patients were able to discontinue AED-treatment and four children resumed development with improvement in cognition and behavior.