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Focal neuronal migration disorders and intractable partial epilepsy: Results of surgical treatment
Author(s) -
Palmini André,
Andermann Frederick,
Olivier André,
Tampieri Donatella,
Robitaille Yvon
Publication year - 1991
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.410300603
Subject(s) - cortical dysplasia , tuberous sclerosis , epilepsy , lesion , medicine , electrocorticography , surgery , electroencephalography , scalp , abnormality , hippocampal sclerosis , partial epilepsy , epilepsy surgery , intractable epilepsy , radiology , temporal lobe , psychiatry
Twenty‐six patients with focal or lateralized neuronal migration disorders and intractable partial epilepsy were treated surgically. Twenty‐four had reliable follow‐up ranging from 1 to 15 years (mean, 5.0). Pathologically, they fell into two categories: focal cortical dysplasia (12 patients) and forme fruste of tuberous sclerosis (8 patients). In the remaining 4 patients, the material was inadequate for histological analysis. Outcome regarding seizure control was assessed according to a classification most sensitive to variations in frequency of major attacks. Ten (42°) of the 24 patients achieved good or excellent outcome, 6(25°) had a worthwhile decrease in seizure frequency, and 8 (33°) had only discrete improvement. The variable most strongly correlated with surgical outcome was the amount of lesion removed. Seventy‐seven percent of patients in whom a complete excision or excision of 50° or more of the lesion was accomplished achieved excellent or good surgical outcome. Conversely, no patient with less than 50° of the lesion removed attained the same result. There was no correlation between other clinical, radiological, or electrographic variables and outcome regarding seizure control. Specifically there was no significant correlation between the amount of excision of the epileptogenic area as judged by scalp electroencephalography and electrocorticography studies, and surgical outcome. In patients with neuronal migration disorders and intractable partial epilepsy, removal of the structural abnormality takes precedence over removal of epileptogenic tissue as the main surgical strategy to achieve seizure control.