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Electro-clinical-pathological correlations in focal cortical dysplasia (FCD) at young ages

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Abstract

The prevalence of focal cortical dysplasia (FCD) in pediatric patients with focal epilepsy is not exactly known because authors of publications in which the etiologies of epilepsies are listed, but which are not dealing specifically with epilepsy surgery issues, tend to lump together the many kinds of malformations of cortical development (MCD), of which FCDs, because of their relative frequency, are the most relevant subtypes. Out of 561 patients with MCD (children and adults) operated at centers in Europe who do feed data into the “European Epilepsy Brain Bank,” 426 (76 %) had FCD.

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Authors and Affiliations

  1. Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen-Klinik Vogtareuth, Krankenhausstr. 20, D - 83569, Vogtareuth, Germany

    Hans Holthausen, Tom Pieper & Peter Winkler

  2. Neuropathological Institute, University Tübingen, Tübingen, Germany

    Ingmar Bluemcke

  3. Neurosurgery Clinic and Clinic for Epilepsy Surgery, Schön Klinik Vogtareuth, Vogtareuth, Germany

    Manfred Kudernatsch

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  1. Hans Holthausen
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  2. Tom Pieper
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  4. Ingmar Bluemcke
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  5. Manfred Kudernatsch
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Corresponding author

Correspondence to Hans Holthausen.

ADDENDUM: imaging in focal cortical dysplasia

ADDENDUM: imaging in focal cortical dysplasia

The principles of MRI with a very low expected rate of false-negative studies are simple: it increased visibility and diagnostic certainty due to the highest reasonably achievable spatial and contrast resolution combined with specialized evaluation of the study. This sounds simple and clear in theory but is in practice not easy to achieve. Recommendations for MRI tend to define a minimal basis and might be directed by common experience and compromise. This is not suitable for maximizing detection of lesions, which are often difficult to find, difficult to exactly define in their extension, and difficult to distinguish from pseudo-lesions and gyral variants. There was a rapid development in MR techniques and specific sequences, and guidelines, recommendations, or methods have been in very general and non-specific terms. Colombo et al. [12] mention T1-weighted inversion recovery as having the best gray-white matter differentiation. Our own experience started also with 2D techniques in patients who underwent pre-surgical evaluations until 2005 but with a higher resolution, particularly in T2 sequences (coronal 1-mm sections with in-plane resolution of 1.0 × 0.5 mm) which were used as 3D substitute.

In the meantime, 3D techniques being common in T1- and T2-weighted gradient echo sequences (T1 1 mm with in-plane resolution of 0.9 × 0.9 mm) were developed for FLAIR and T2 spin echo and were used during the last few years with a slice thickness and in-plane resolution of 0.6 mm in T2 space sequences (Siemens) and slice thickness of 1.2 mm and in-plane resolution of 0.9 × 0.6 mm in 3D FLAIR sequences. These sequences were tested against 2D T2 and 2D inversion recovery sequences and were found to be better regarding contrast than 2D T2 images and equal or slightly better regarding contrast than inversion recovery imaging. The 3D T2 spin-echo imaging was, however, far superior to all other images in 3D or three-planar evaluation, so that one plane of partitions (slices) is sufficient, which was axial for T2 and coronal for FLAIR. The problem with these sequences is the contrast resolution: in T2 space imaging, the spatial l resolution could be achieved in 15–20 min, but a very good contrast resolution needs a long TR of around 4,000 ms and TE of approximately 350 ms. To gain such a contrast with 1.5 T, the time is around 1 h for one 3D sequence. This time can only be reduced (but not halved) by performing the examination with a 3-T system. Another pre-requisition is that one needs very skilled pediatric anesthesiologists and dedicated technicians, as well as an adequate MRI machine to keep respiration- and vibration-induced head motions and inhomogeneities to a minimum. Last but not the least, one needs time and dedication for evaluation of the two 3D datasets (e.g., 320 images in T2 space), using three-planar and fusion techniques.

P. Winkler

(Pediatric Neurology)

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Holthausen, H., Pieper, T., Winkler, P. et al. Electro-clinical-pathological correlations in focal cortical dysplasia (FCD) at young ages. Childs Nerv Syst 30, 2015–2026 (2014). https://doi.org/10.1007/s00381-014-2549-6

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  • DOI: https://doi.org/10.1007/s00381-014-2549-6

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