Advertisement

Child's Nervous System

, Volume 30, Issue 11, pp 1885–1895 | Cite as

Cognitive and epilepsy outcomes after epilepsy surgery caused by focal cortical dysplasia in children: early intervention maybe better

  • Hsin-Hung ChenEmail author
  • Chien Chen
  • Sheng-Che Hung
  • Sheng-Yuan Liang
  • Shih-Chieh Lin
  • Ting-Rong Hsu
  • Tzu-Chen Yeh
  • Hsiang-Yu Yu
  • Chun-Fu Lin
  • Sanford P. C. Hsu
  • Muh-Lii Liang
  • Tsui-Fen Yang
  • Lee-Shing Chu
  • Yung-Yang Lin
  • Kai-Ping Chang
  • Shang-Yeong Kwan
  • Donald M. Ho
  • Tai-Tong Wong
  • Yang-Hsin Shih
Special Annual Issue

Abstract

Background

Focal cortical dysplasia (FCD) is a specific malformation of cortical development harboring intrinsic epileptogenicity, and most of the patients develop drug-resistant epilepsy in early childhood. The detrimental effects of early and frequent seizures on cognitive function in children are significant clinical issues. In this study, we evaluate the effects of early surgical intervention of FCD on epilepsy outcome and cognitive development.

Methods

From 2006 to 2013, 30 children younger than 18 years old underwent resective surgery for FCDs at Taipei Veterans General Hospital. The mean age at surgery was 10.0 years (range 1.7 to 17.6 years). There were 21 boys and 9 girls. In this retrospective clinical study, seizure outcome, cognitive function, and quality of life were evaluated. To evaluate the effects to outcomes on early interventions, the patients were categorized into four groups according to age of seizure onset, duration of seizure before surgery, and severity of cognitive deficits.

Results

Eleven of 22 (50 %) patients demonstrated developmental delay preoperatively. The Engel seizure outcome achievements were class I in 21 (70 %), class II in 2 (7 %), class III in 6 (20 %), and class IV in 1 (3 %) patients. The locations of FCDs resected were in the frontal lobe in 18 cases, temporal lobe in 7, parietal lobe in 2, and in bilobes including frontoparietal lobe in 2 and parieto-occipital lobes in 1. Eight cases that had FCDs involved in the rolandic cortex presented hemiparesis before surgical resection. Motor function in four of them improved after operation. The histopathological types of FCDs were type Ia in 1, type Ib in 7, type IIa in 7, type IIb in 12, and type III in 3 patients. FCDs were completely resected in 20 patients. Eighteen (90 %) of them were seizure free (p < 0.001) with three patients that received more than one surgery to accomplish complete resection. The patients who had early seizure onset, no significant cognitive function deficit, and early surgical intervention with complete resection in less than 2 years of seizure duration showed best outcomes on seizure control, cognitive function, and quality of life.

Conclusion

Delay in cognitive development and poor quality of life is common in children treated for FCDs. Early surgical intervention and complete resection of the lesion help for a better seizure control, cognitive function development, and quality of life. FCDs involved eloquent cortex may not prohibit complete resection for better outcomes.

Keywords

Cognitive function Childhood epilepsy Epilepsy surgery outcome Focal cortical dysplasia Quality of life 

References

  1. 1.
    Taylor DC, Falconer MA, Bruton CJ, Corsellis JA (1971) Focal dysplasia of the cerebral cortex in epilepsy. J Neurol Neurosurg Psychiatry 34:369–387PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Blumcke I, Thom M, Aronica E, Armstrong DD, Vinters HV, Palmini A, Jacques TS, Avanzini G, Barkovich AJ, Battaglia G, Becker A, Cepeda C, Cendes F, Colombo N, Crino P, Cross JH, Delalande O, Dubeau F, Duncan J, Guerrini R, Kahane P, Mathern G, Najm I, Ozkara C, Raybaud C, Represa A, Roper SN, Salamon N, Schulze-Bonhage A, Tassi L, Vezzani A, Spreafico R (2011) The clinicopathologic spectrum of focal cortical dysplasias: a consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission. Epilepsia 52:158–174PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Sisodiya SM, Fauser S, Cross JH, Thom M (2009) Focal cortical dysplasia type II: biological features and clinical perspectives. Lancet Neurol 8:830–843PubMedCrossRefGoogle Scholar
  4. 4.
    Raymond AA, Fish DR, Sisodiya SM, Alsanjari N, Stevens JM, Shorvon SD (1995) Abnormalities of gyration, heterotopias, tuberous sclerosis, focal cortical dysplasia, microdysgenesis, dysembryoplastic neuroepithelial tumour and dysgenesis of the archicortex in epilepsy. Clinical, EEG and neuroimaging features in 100 adult patients. Brain : J Neurol 118(Pt 3):629–660CrossRefGoogle Scholar
  5. 5.
    Semah F, Picot MC, Adam C, Broglin D, Arzimanoglou A, Bazin B, Cavalcanti D, Baulac M (1998) Is the underlying cause of epilepsy a major prognostic factor for recurrence? Neurology 51:1256–1262PubMedCrossRefGoogle Scholar
  6. 6.
    Barkovich AJ, Kuzniecky RI, Bollen AW, Grant PE (1997) Focal transmantle dysplasia: a specific malformation of cortical development. Neurology 49:1148–1152PubMedCrossRefGoogle Scholar
  7. 7.
    Bastos AC, Comeau RM, Andermann F, Melanson D, Cendes F, Dubeau F, Fontaine S, Tampieri D, Olivier A (1999) Diagnosis of subtle focal dysplastic lesions: curvilinear reformatting from three-dimensional magnetic resonance imaging. Ann Neurol 46:88–94PubMedCrossRefGoogle Scholar
  8. 8.
    Chan S, Chin SS, Nordli DR, Goodman RR, DeLaPaz RL, Pedley TA (1998) Prospective magnetic resonance imaging identification of focal cortical dysplasia, including the non-balloon cell subtype. Ann Neurol 44:749–757PubMedCrossRefGoogle Scholar
  9. 9.
    Hirabayashi S, Binnie CD, Janota I, Polkey CE (1993) Surgical treatment of epilepsy due to cortical dysplasia: clinical and EEG findings. J Neurol Neurosurg Psychiatry 56:765–770PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Keene DL, Jimenez CC, Ventureyra E (1998) Cortical microdysplasia and surgical outcome in refractory epilepsy of childhood. Pediatr Neurosurg 29:69–72PubMedCrossRefGoogle Scholar
  11. 11.
    Hong SC, Kang KS, Seo DW, Hong SB, Lee M, Nam DH, Lee JI, Kim JS, Shin HJ, Park K, Eoh W, Suh YL, Kim JH (2000) Surgical treatment of intractable epilepsy accompanying cortical dysplasia. J Neurosurg 93:766–773PubMedCrossRefGoogle Scholar
  12. 12.
    Hader WJ, Mackay M, Otsubo H, Chitoku S, Weiss S, Becker L, Snead OC 3rd, Rutka JT (2004) Cortical dysplastic lesions in children with intractable epilepsy: role of complete resection. J Neurosurg 100:110–117PubMedGoogle Scholar
  13. 13.
    Cohen-Gadol AA, Ozduman K, Bronen RA, Kim JH, Spencer DD (2004) Long-term outcome after epilepsy surgery for focal cortical dysplasia. J Neurosurg 101:55–65PubMedCrossRefGoogle Scholar
  14. 14.
    Kral T, Clusmann H, Blumcke I, Fimmers R, Ostertun B, Kurthen M, Schramm J (2003) Outcome of epilepsy surgery in focal cortical dysplasia. J Neurol Neurosurg Psychiatry 74:183–188PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Wyllie E, Comair YG, Kotagal P, Raja S, Ruggieri P (1996) Epilepsy surgery in infants. Epilepsia 37:625–637PubMedCrossRefGoogle Scholar
  16. 16.
    Vasconcellos E, Wyllie E, Sullivan S, Stanford L, Bulacio J, Kotagal P, Bingaman W (2001) Mental retardation in pediatric candidates for epilepsy surgery: the role of early seizure onset. Epilepsia 42:268–274PubMedGoogle Scholar
  17. 17.
    Freitag H, Tuxhorn I (2005) Cognitive function in preschool children after epilepsy surgery: rationale for early intervention. Epilepsia 46:561–567PubMedCrossRefGoogle Scholar
  18. 18.
    Battaglia D, Rando T, Deodato F, Bruccini G, Baglio G, Frisone MF, Panto T, Tortorella G, Guzzetta F (1999) Epileptic disorders with onset in the first year of life: neurological and cognitive outcome. Eur J Paediatr Neurol : EJPN : Off J Eur Paediatr Neurol Soc 3:95–103CrossRefGoogle Scholar
  19. 19.
    Hermann B, Seidenberg M, Bell B, Rutecki P, Sheth R, Ruggles K, Wendt G, O'Leary D, Magnotta V (2002) The neurodevelopmental impact of childhood-onset temporal lobe epilepsy on brain structure and function. Epilepsia 43:1062–1071PubMedCrossRefGoogle Scholar
  20. 20.
    Muter V, Taylor S, Vargha-Khadem F (1997) A longitudinal study of early intellectual development in hemiplegic children. Neuropsychologia 35:289–298PubMedCrossRefGoogle Scholar
  21. 21.
    Smith ML, Elliott IM, Lach L (2002) Cognitive skills in children with intractable epilepsy: comparison of surgical and nonsurgical candidates. Epilepsia 43:631–637PubMedCrossRefGoogle Scholar
  22. 22.
    Engel Jr J (1993) Outcome with respect to epileptic seizures. Surgical treatment of the epilepsies: 609-621Google Scholar
  23. 23.
    Otsubo H, Ochi A, Elliott I, Chuang SH, Rutka JT, Jay V, Aung M, Sobel DF, Snead OC (2001) MEG predicts epileptic zone in lesional extrahippocampal epilepsy: 12 pediatric surgery cases. Epilepsia 42:1523–1530PubMedCrossRefGoogle Scholar
  24. 24.
    Phi JH, Cho BK, Wang KC, Lee JY, Hwang YS, Kim KJ, Chae JH, Kim IO, Park SH, Kim SK (2010) Longitudinal analyses of the surgical outcomes of pediatric epilepsy patients with focal cortical dysplasia. J Neurosurg Pediatr 6:49–56PubMedCrossRefGoogle Scholar
  25. 25.
    Edwards JC, Wyllie E, Ruggeri PM, Bingaman W, Luders H, Kotagal P, Dinner DS, Morris HH, Prayson RA, Comair YG (2000) Seizure outcome after surgery for epilepsy due to malformation of cortical development. Neurology 55:1110–1114PubMedCrossRefGoogle Scholar
  26. 26.
    Bjornaes H, Stabell K, Henriksen O, Loyning Y (2001) The effects of refractory epilepsy on intellectual functioning in children and adults. A longitudinal study. Seizure : J Br Epilepsy Assoc 10:250–259CrossRefGoogle Scholar
  27. 27.
    Neyens LG, Aldenkamp AP, Meinardi HM (1999) Prospective follow-up of intellectual development in children with a recent onset of epilepsy. Epilepsy Res 34:85–90PubMedCrossRefGoogle Scholar
  28. 28.
    Harris JC (1998) Developmental neuropsychiatry: assessment, diagnosis, and treatment of developmental disorders. Oxford University PressGoogle Scholar
  29. 29.
    Elger CE, Helmstaedter C, Kurthen M (2004) Chronic epilepsy and cognition. Lancet Neurol 3:663–672PubMedCrossRefGoogle Scholar
  30. 30.
    Luton LM, Burns TG, DeFilippis N (2010) Frontal lobe epilepsy in children and adolescents: a preliminary neuropsychological assessment of executive function. Arch Clin Neuropsychol : Off J Nat’l Acad Neuropsychologists 25:762–770CrossRefGoogle Scholar
  31. 31.
    Weaver KE, Chaovalitwongse WA, Novotny EJ, Poliakov A, Grabowski TG, Ojemann JG (2013) Local functional connectivity as a pre-surgical tool for seizure focus identification in non-lesion, focal epilepsy. Front Neurol 4:43PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Stufflebeam SM, Liu H, Sepulcre J, Tanaka N, Buckner RL, Madsen JR (2011) Localization of focal epileptic discharges using functional connectivity magnetic resonance imaging. J Neurosurg 114:1693–1697PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Pondal-Sordo M, Diosy D, Tellez-Zenteno JF, Girvin JP, Wiebe S (2006) Epilepsy surgery involving the sensory-motor cortex. Brain : J Neurol 129:3307–3314CrossRefGoogle Scholar
  34. 34.
    Benifla M, Sala F Jr, Jane J, Otsubo H, Ochi A, Drake J, Weiss S, Donner E, Fujimoto A, Holowka S, Widjaja E, Snead OC 3rd, Smith ML, Tamber MS, Rutka JT (2009) Neurosurgical management of intractable rolandic epilepsy in children: role of resection in eloquent cortex. Clin Article J Neurosurg Pediatr 4:199–216CrossRefGoogle Scholar
  35. 35.
    Behdad A, Limbrick DD Jr, Bertrand ME, Smyth MD (2009) Epilepsy surgery in children with seizures arising from the rolandic cortex. Epilepsia 50:1450–1461PubMedCrossRefGoogle Scholar
  36. 36.
    Blount JP, Langburt W, Otsubo H, Chitoku S, Ochi A, Weiss S, Snead OC, Rutka JT (2004) Multiple subpial transections in the treatment of pediatric epilepsy. J Neurosurg 100:118–124PubMedGoogle Scholar
  37. 37.
    Schramm J, Aliashkevich AF, Grunwald T (2002) Multiple subpial transections: outcome and complications in 20 patients who did not undergo resection. J Neurosurg 97:39–47PubMedCrossRefGoogle Scholar
  38. 38.
    Spencer SS, Schramm J, Wyler A, O'Connor M, Orbach D, Krauss G, Sperling M, Devinsky O, Elger C, Lesser R, Mulligan L, Westerveld M (2002) Multiple subpial transection for intractable partial epilepsy: an international meta-analysis. Epilepsia 43:141–145PubMedCrossRefGoogle Scholar
  39. 39.
    Hur YJ, Kang HC, Kim DS, Choi SR, Kim HD, Lee JS (2011) Uncovered primary seizure foci in Lennox-Gastaut syndrome after corpus callosotomy. Brain Dev 33:672–677PubMedCrossRefGoogle Scholar
  40. 40.
    Gaillard WD, Chiron C, Cross JH, Harvey AS, Kuzniecky R, Hertz-Pannier L, Vezina LG, Ilae CNSP (2009) Guidelines for imaging infants and children with recent-onset epilepsy. Epilepsia 50:2147–2153PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Hsin-Hung Chen
    • 1
    • 8
    Email author
  • Chien Chen
    • 2
    • 8
  • Sheng-Che Hung
    • 3
    • 8
  • Sheng-Yuan Liang
    • 6
  • Shih-Chieh Lin
    • 5
    • 8
  • Ting-Rong Hsu
    • 4
    • 8
  • Tzu-Chen Yeh
    • 3
    • 8
  • Hsiang-Yu Yu
    • 2
    • 8
  • Chun-Fu Lin
    • 1
    • 8
  • Sanford P. C. Hsu
    • 1
    • 8
  • Muh-Lii Liang
    • 1
    • 8
  • Tsui-Fen Yang
    • 6
    • 8
  • Lee-Shing Chu
    • 7
    • 8
  • Yung-Yang Lin
    • 2
    • 8
  • Kai-Ping Chang
    • 4
    • 8
  • Shang-Yeong Kwan
    • 2
    • 8
  • Donald M. Ho
    • 5
    • 8
  • Tai-Tong Wong
    • 1
    • 8
  • Yang-Hsin Shih
    • 1
    • 8
  1. 1.Department of Neurosurgery, The Neurological InstituteTaipei Veterans General HospitalTaipeiTaiwan
  2. 2.Department of Neurology, The Neurological InstituteTaipei Veterans General HospitalTaipeiTaiwan
  3. 3.Department of RadiologyTaipei Veterans General HospitalTaipeiTaiwan
  4. 4.Department of PediatricsTaipei Veterans General HospitalTaipeiTaiwan
  5. 5.Department of PathologyTaipei Veterans General HospitalTaipeiTaiwan
  6. 6.Department of RehabilitationTaipei Veterans General HospitalTaipeiTaiwan
  7. 7.Department of Nuclear MedicineTaipei Veterans General HospitalTaipeiTaiwan
  8. 8.National Yang-Ming University School of MedicineTaipeiTaiwan

Personalised recommendations