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Surgical treatment of polymicrogyria‐related epilepsy
Author(s) -
Cossu Massimo,
Pelliccia Veronica,
Gozzo Francesca,
Casaceli Giuseppe,
Francione Stefano,
Nobili Lino,
Mai Roberto,
Castana Laura,
Sartori Ivana,
Cardinale Francesco,
Lo Russo Giorgio,
Tassi Laura
Publication year - 2016
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13589
Subject(s) - polymicrogyria , epilepsy , medicine , epilepsy surgery , neuroscience , psychology , psychiatry
Summary Objective The role of resective surgery in the treatment of polymicrogyria ( PMG )–related focal epilepsy is uncertain. Our aim was to retrospectively evaluate the seizure outcome in a consecutive series of patients with PMG ‐related epilepsy who received, or did not receive, surgical treatment, and to outline the clinical characteristics of patients who underwent surgery. Methods We evaluated 64 patients with epilepsy associated with magnetic resonance imaging ( MRI )–documented PMG . After presurgical evaluation, 32 patients were excluded from surgical treatment and 32 were offered surgery, which was declined by 8 patients. Seizure outcome was assessed in the 40 nonsurgical and 24 surgical patients. Results Of 40 nonsurgical patients, 8 (20%) were seizure‐free after a mean follow‐up of 91.7 ± (standard deviation) 59.5 months. None of the eight patients who declined surgical treatment was seizure‐free (mean follow‐up: 74.3 ± 60.6 months). These seizure outcomes differ significantly (p = 0.5 and p = 0.0003, respectively) from that of the 24 surgical patients, 18 of whom (66.7%) were Engel's class I postoperatively (mean follow‐up: 66.5 ± 54.0 months). Of the eight patients excluded from surgery for seizure control at first visit, two had seizure recurrence at last contact. At last contact, antiepileptic drugs ( AED s) had been withdrawn in 6 of 24 surgical and in one of 40 nonsurgical cases (p = 0.0092). Significance The present study indicates that, at least in a subset of adequately selected patients with PMG ‐related epilepsy, surgery may provide excellent seizure outcomes. Furthermore, it suggests that surgery is superior to AED s for achieving seizure freedom in these cases.