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

研究成果: 雜誌貢獻文章

22 引文 斯高帕斯(Scopus)

摘要

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.

原文英語
頁(從 - 到)1885-1895
頁數11
期刊Child's Nervous System
30
發行號11
DOIs
出版狀態已發佈 - 一月 1 2014
對外發佈Yes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

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    Chen, H. H., Chen, C., Hung, S. C., Liang, S. Y., Lin, S. C., Hsu, T. R., Yeh, T. C., Yu, H. Y., Lin, C. F., Hsu, S. P. C., Liang, M. L., Yang, T. F., Chu, L. S., Lin, Y. Y., Chang, K. P., Kwan, S. Y., Ho, D. M., Wong, T-T., & Shih, Y. H. (2014). Cognitive and epilepsy outcomes after epilepsy surgery caused by focal cortical dysplasia in children: early intervention maybe better. Child's Nervous System, 30(11), 1885-1895. https://doi.org/10.1007/s00381-014-2463-y