Focal cortical dysplasia-associated epilepsies in adults: surgical treatment

Sitnikov A. R., Grigoryan Yu. A., Mishnyakova L. P.

Keywords: epilepsy, focal cortical dysplasia, topectomy

Objectives: to analyse the morphological findings and results of surgical treatment of adult patients with FCD – associated epilepsies.

Materials and methods: 8 patients with FCD were operated. The topectomy was done in all cases after pre-surgical evaluation which obligatory included an MRI – scan, EEG – video and invasive corticography for every patient. In two cases was performed awake-asleep-awake craniotomy for patient with FCD located in eloquent brain areas.

Results: The mean age of patients was 26 years (between 17 and 33 years). The mean duration of disease was 9.7 years. There were 4 females and 4 males. The MRI scan showed obvious FCD in 5 patients. Three patients have had FCD in temporal lobe (one of them in dominant hemisphere), and five patients – in frontal lobe.  All patients underwent an invasive corticography before the surgical resection to identify the epileptogenic region which was resected afterwards. The morphological examination revealed FCD I type in 2 cases, FCD IIa in 3 patients and IIb –in 3 patients. The one –year up to three-years follow – up showed complete freedom from seizures in 4 patients (Engel Ia), 3 patients achieved Engel II (rare partial seizures) and one patient has Engel III (patient withdrew from medication just after the operation without permission of her physician).

CONCLUSION: FCD – associated drug-resistant epilepsies in adult patients can be successfully treated by topectomy, however doctors have to keep the protocol of pre-surgical evaluation to achieve the best results.