Division of Epilepsy Clinic and Experimental Neurophysiology, C. Besta Neurological Institute IRCCS Foundation, Milan, Italy.
Epileptic Disord. 2010 Sep;12(3):181-91. doi: 10.1684/epd.2010.0327. Epub 2010 Jul 27.
Pre-surgical and post-surgical data were examined and compared from 215 consecutive patients undergoing surgery for intractable epilepsy. Patients were selected on the basis of a proven histopathological diagnosis of type I focal cortical dysplasia (FCD I), alone or associated with other lesions. The patients were divided into five sub-groups: i) 66 with isolated FCD I, ii) 76 with FCD I and hippocampal sclerosis, iii) 49 with FCD I and tumours, iv) 16 with FCD I and other malformations of cortical development and v) eight with FCD I and anoxic-ischaemic or inflammatory diseases. The duration of epilepsy was greatest in patients with FCD I associated with hippocampal sclerosis, and those with isolated FCD I showed the highest seizure frequency at the time of surgery. Hippocampal sclerosis and tumours were the most frequent pathological lesions associated with FCD I in temporal lobe epilepsy. Febrile seizures significantly correlated with the presence of hippocampal sclerosis and FCD I. Isolated FCD I was observed in 31% of the patients, characterized by frequent seizures, negative magnetic resonance imaging, and frequent frontal or multilobar involvement. In comparison to patients with FCD I associated with hippocampal sclerosis, MCD or tumours, the patients with isolated FCD I had a worse post-surgical outcome (46% in class I). Our findings indicate that there is a high incidence of FCD I associated with other apparently distinct pathologies, particularly those affecting the temporal lobe, and highlight the need for a comprehensive clinicopathological approach for the classification of FCD I.
对 215 例接受难治性癫痫手术的连续患者的术前和术后数据进行了检查和比较。患者是根据 I 型局灶性皮质发育不良（FCD I）的明确组织病理学诊断选择的，单独或与其他病变一起。患者分为五个亚组：i）66 例单纯 FCD I，ii）76 例 FCD I 伴海马硬化，iii）49 例 FCD I 伴肿瘤，iv）16 例 FCD I 伴其他皮质发育畸形，v）8 例 FCD I 伴缺氧缺血或炎症性疾病。伴有海马硬化的 FCD I 患者的癫痫持续时间最长，而单纯 FCD I 患者在手术时的癫痫发作频率最高。海马硬化和肿瘤是颞叶癫痫中最常见的与 FCD I 相关的病理病变。热性惊厥与海马硬化和 FCD I 的存在显著相关。孤立性 FCD I 见于 31%的患者，其特征为频繁发作、磁共振成像阴性和频繁的额或多叶受累。与伴有海马硬化、MCD 或肿瘤的 FCD I 患者相比，单纯 FCD I 患者的术后结果较差（I 级 46%）。我们的发现表明，FCD I 与其他明显不同的病理情况相关的发生率很高，特别是那些影响颞叶的情况，这突出了需要综合临床病理方法对 FCD I 进行分类。
