Cognitive and epilepsy outcomes after epilepsy surgery caused by focal cortical dysplasia in children

early intervention maybe better

Hsin Hung Chen, Chien Chen, Sheng Che Hung, Sheng Yuan Liang, Shih Chieh Lin, Ting Rong Hsu, Tzu Chen Yeh, Hsiang Yu Yu, Chun Fu Lin, Sanford P.C. Hsu, Muh Lii Liang, Tsui Fen Yang, Lee Shing Chu, Yung Yang Lin, Kai Ping Chang, Shang Yeong Kwan, Donald M. Ho, Tai-Tong Wong, Yang Hsin Shih

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Results: Eleven of 22 (50 %) patients demonstrated developmental delay preoperatively. The Engel seizure outcome achievements were class I in 21 (70 %), class II in 2 (7 %), class III in 6 (20 %), and class IV in 1 (3 %) patients. The locations of FCDs resected were in the frontal lobe in 18 cases, temporal lobe in 7, parietal lobe in 2, and in bilobes including frontoparietal lobe in 2 and parieto-occipital lobes in 1. Eight cases that had FCDs involved in the rolandic cortex presented hemiparesis before surgical resection. Motor function in four of them improved after operation. The histopathological types of FCDs were type Ia in 1, type Ib in 7, type IIa in 7, type IIb in 12, and type III in 3 patients. FCDs were completely resected in 20 patients. Eighteen (90 %) of them were seizure free (p < 0.001) with three patients that received more than one surgery to accomplish complete resection. The patients who had early seizure onset, no significant cognitive function deficit, and early surgical intervention with complete resection in less than 2 years of seizure duration showed best outcomes on seizure control, cognitive function, and quality of life.

Conclusion: Delay in cognitive development and poor quality of life is common in children treated for FCDs. Early surgical intervention and complete resection of the lesion help for a better seizure control, cognitive function development, and quality of life. FCDs involved eloquent cortex may not prohibit complete resection for better outcomes.

Background: Focal cortical dysplasia (FCD) is a specific malformation of cortical development harboring intrinsic epileptogenicity, and most of the patients develop drug-resistant epilepsy in early childhood. The detrimental effects of early and frequent seizures on cognitive function in children are significant clinical issues. In this study, we evaluate the effects of early surgical intervention of FCD on epilepsy outcome and cognitive development.

Methods: From 2006 to 2013, 30 children younger than 18 years old underwent resective surgery for FCDs at Taipei Veterans General Hospital. The mean age at surgery was 10.0 years (range 1.7 to 17.6 years). There were 21 boys and 9 girls. In this retrospective clinical study, seizure outcome, cognitive function, and quality of life were evaluated. To evaluate the effects to outcomes on early interventions, the patients were categorized into four groups according to age of seizure onset, duration of seizure before surgery, and severity of cognitive deficits.

Original languageEnglish
Pages (from-to)1885-1895
Number of pages11
JournalChild's Nervous System
Volume30
Issue number11
DOIs
Publication statusPublished - Jan 1 2014
Externally publishedYes

Fingerprint

Malformations of Cortical Development
Epilepsy
Seizures
Cognition
Quality of Life
Veterans Hospitals
Occipital Lobe
Parietal Lobe
Frontal Lobe
Paresis
Temporal Lobe
Age of Onset
General Hospitals
Retrospective Studies

Keywords

  • Childhood epilepsy
  • Cognitive function
  • Epilepsy surgery outcome
  • Focal cortical dysplasia
  • Quality of life

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Cognitive and epilepsy outcomes after epilepsy surgery caused by focal cortical dysplasia in children : early intervention maybe better. / Chen, Hsin Hung; Chen, Chien; Hung, Sheng Che; Liang, Sheng Yuan; Lin, Shih Chieh; Hsu, Ting Rong; Yeh, Tzu Chen; Yu, Hsiang Yu; Lin, Chun Fu; Hsu, Sanford P.C.; Liang, Muh Lii; Yang, Tsui Fen; Chu, Lee Shing; Lin, Yung Yang; Chang, Kai Ping; Kwan, Shang Yeong; Ho, Donald M.; Wong, Tai-Tong; Shih, Yang Hsin.

In: Child's Nervous System, Vol. 30, No. 11, 01.01.2014, p. 1885-1895.

Research output: Contribution to journalArticle

Chen, HH, Chen, C, Hung, SC, Liang, SY, Lin, SC, Hsu, TR, Yeh, TC, Yu, HY, Lin, CF, Hsu, SPC, Liang, ML, Yang, TF, Chu, LS, Lin, YY, Chang, KP, Kwan, SY, Ho, DM, Wong, T-T & Shih, YH 2014, 'Cognitive and epilepsy outcomes after epilepsy surgery caused by focal cortical dysplasia in children: early intervention maybe better', Child's Nervous System, vol. 30, no. 11, pp. 1885-1895. https://doi.org/10.1007/s00381-014-2463-y
Chen, Hsin Hung ; Chen, Chien ; Hung, Sheng Che ; Liang, Sheng Yuan ; Lin, Shih Chieh ; Hsu, Ting Rong ; Yeh, Tzu Chen ; Yu, Hsiang Yu ; Lin, Chun Fu ; Hsu, Sanford P.C. ; Liang, Muh Lii ; Yang, Tsui Fen ; Chu, Lee Shing ; Lin, Yung Yang ; Chang, Kai Ping ; Kwan, Shang Yeong ; Ho, Donald M. ; Wong, Tai-Tong ; Shih, Yang Hsin. / Cognitive and epilepsy outcomes after epilepsy surgery caused by focal cortical dysplasia in children : early intervention maybe better. In: Child's Nervous System. 2014 ; Vol. 30, No. 11. pp. 1885-1895.
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TY - JOUR

T1 - Cognitive and epilepsy outcomes after epilepsy surgery caused by focal cortical dysplasia in children

T2 - early intervention maybe better

AU - Chen, Hsin Hung

AU - Chen, Chien

AU - Hung, Sheng Che

AU - Liang, Sheng Yuan

AU - Lin, Shih Chieh

AU - Hsu, Ting Rong

AU - Yeh, Tzu Chen

AU - Yu, Hsiang Yu

AU - Lin, Chun Fu

AU - Hsu, Sanford P.C.

AU - Liang, Muh Lii

AU - Yang, Tsui Fen

AU - Chu, Lee Shing

AU - Lin, Yung Yang

AU - Chang, Kai Ping

AU - Kwan, Shang Yeong

AU - Ho, Donald M.

AU - Wong, Tai-Tong

AU - Shih, Yang Hsin

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Results: Eleven of 22 (50 %) patients demonstrated developmental delay preoperatively. The Engel seizure outcome achievements were class I in 21 (70 %), class II in 2 (7 %), class III in 6 (20 %), and class IV in 1 (3 %) patients. The locations of FCDs resected were in the frontal lobe in 18 cases, temporal lobe in 7, parietal lobe in 2, and in bilobes including frontoparietal lobe in 2 and parieto-occipital lobes in 1. Eight cases that had FCDs involved in the rolandic cortex presented hemiparesis before surgical resection. Motor function in four of them improved after operation. The histopathological types of FCDs were type Ia in 1, type Ib in 7, type IIa in 7, type IIb in 12, and type III in 3 patients. FCDs were completely resected in 20 patients. Eighteen (90 %) of them were seizure free (p < 0.001) with three patients that received more than one surgery to accomplish complete resection. The patients who had early seizure onset, no significant cognitive function deficit, and early surgical intervention with complete resection in less than 2 years of seizure duration showed best outcomes on seizure control, cognitive function, and quality of life.Conclusion: Delay in cognitive development and poor quality of life is common in children treated for FCDs. Early surgical intervention and complete resection of the lesion help for a better seizure control, cognitive function development, and quality of life. FCDs involved eloquent cortex may not prohibit complete resection for better outcomes.Background: Focal cortical dysplasia (FCD) is a specific malformation of cortical development harboring intrinsic epileptogenicity, and most of the patients develop drug-resistant epilepsy in early childhood. The detrimental effects of early and frequent seizures on cognitive function in children are significant clinical issues. In this study, we evaluate the effects of early surgical intervention of FCD on epilepsy outcome and cognitive development.Methods: From 2006 to 2013, 30 children younger than 18 years old underwent resective surgery for FCDs at Taipei Veterans General Hospital. The mean age at surgery was 10.0 years (range 1.7 to 17.6 years). There were 21 boys and 9 girls. In this retrospective clinical study, seizure outcome, cognitive function, and quality of life were evaluated. To evaluate the effects to outcomes on early interventions, the patients were categorized into four groups according to age of seizure onset, duration of seizure before surgery, and severity of cognitive deficits.

AB - Results: Eleven of 22 (50 %) patients demonstrated developmental delay preoperatively. The Engel seizure outcome achievements were class I in 21 (70 %), class II in 2 (7 %), class III in 6 (20 %), and class IV in 1 (3 %) patients. The locations of FCDs resected were in the frontal lobe in 18 cases, temporal lobe in 7, parietal lobe in 2, and in bilobes including frontoparietal lobe in 2 and parieto-occipital lobes in 1. Eight cases that had FCDs involved in the rolandic cortex presented hemiparesis before surgical resection. Motor function in four of them improved after operation. The histopathological types of FCDs were type Ia in 1, type Ib in 7, type IIa in 7, type IIb in 12, and type III in 3 patients. FCDs were completely resected in 20 patients. Eighteen (90 %) of them were seizure free (p < 0.001) with three patients that received more than one surgery to accomplish complete resection. The patients who had early seizure onset, no significant cognitive function deficit, and early surgical intervention with complete resection in less than 2 years of seizure duration showed best outcomes on seizure control, cognitive function, and quality of life.Conclusion: Delay in cognitive development and poor quality of life is common in children treated for FCDs. Early surgical intervention and complete resection of the lesion help for a better seizure control, cognitive function development, and quality of life. FCDs involved eloquent cortex may not prohibit complete resection for better outcomes.Background: Focal cortical dysplasia (FCD) is a specific malformation of cortical development harboring intrinsic epileptogenicity, and most of the patients develop drug-resistant epilepsy in early childhood. The detrimental effects of early and frequent seizures on cognitive function in children are significant clinical issues. In this study, we evaluate the effects of early surgical intervention of FCD on epilepsy outcome and cognitive development.Methods: From 2006 to 2013, 30 children younger than 18 years old underwent resective surgery for FCDs at Taipei Veterans General Hospital. The mean age at surgery was 10.0 years (range 1.7 to 17.6 years). There were 21 boys and 9 girls. In this retrospective clinical study, seizure outcome, cognitive function, and quality of life were evaluated. To evaluate the effects to outcomes on early interventions, the patients were categorized into four groups according to age of seizure onset, duration of seizure before surgery, and severity of cognitive deficits.

KW - Childhood epilepsy

KW - Cognitive function

KW - Epilepsy surgery outcome

KW - Focal cortical dysplasia

KW - Quality of life

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U2 - 10.1007/s00381-014-2463-y

DO - 10.1007/s00381-014-2463-y

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JO - Child's Nervous System

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