Polymicrogyria: the bigger the malformation, the worse the epilepsy, is that true?

Polymicrogyria (PMG) is a common malformation of cortical development (MCD) related to cortical organization defects, resulting in overfolding and abnormal lamination of the cortex. Epilepsy is one of the main clinical features of this syndrome, although frequency, severity and long-term outcome of seizures in these patients are not known. We describe three patients with polymicrogyriarelated epilepsy: clinical, electroencephalographic and neuroimaging data have been analyzed. Interestingly the severity of the malformations was not correlated to the severity of epilepsy: indeed in the patient with isolated PMG the longterm outcome was poor, with severe drug-resistant epilepsy and cognitive decline, while in the patients with widespread malformations (PMG associated to nodular heterotopia, focal cortical dysplasia and other malformations of cortical development) the epilepsy outcome resulted excellent. Future studies of prognostic data in large cohorts of patients with PMG and epilepsy