"C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy.
Epilepsia. 2013 Dec;54 Suppl 9:115-22. doi: 10.1111/epi.12455.
The goal of the present study was to evaluate the clinical characteristics and postoperative seizure outcome of epileptogenic tumors associated with focal cortical dysplasias (FCDs) compared to both solitary FCD type I and solitary tumors. Particular attention is given to FCD type IIIb (tumors associated with FCD type I), which have been recently classified as a separate entity. We retrospectively reviewed the clinical charts of 1,109 patients who were operated on for drug-resistant focal epilepsy, including 492 patients with a histologic diagnosis of solitary FCD I and II (83 and 157 cases, respectively), solitary tumors (179 cases), and FCD-associated tumors (73 cases, 58 of which met the criteria of FCD IIIb of the new International League Against Epilepsy [ILAE] classification). The different subgroups were evaluated for clinical characteristics and postoperative surgical outcome. Clinical variables and postoperative seizure outcome of patients with coexisting tumor and FCDs (FCD IIIb and tumor associated FCD II) were similar to those of patients with a solitary tumor and differed significantly from patients with solitary FCDs. Nevertheless, tumors associated with FCDs are characterized by a striking male predominance and a higher seizure frequency as compared to solitary tumors. Patients with drug-resistant focal epilepsy secondary to a solitary tumor or with a tumor-associated FCD have similar basic clinical presentation and postoperative seizure outcome. Nevertheless, the epileptogenic contribution of the associated FCDs can be crucial, and it needs to be adequately assessed. The impact of FCD on tumor-related epilepsy deserves future research in order to optimize the surgical strategies aimed at seizure relief.
本研究旨在评估与局灶性皮质发育不良（FCD）相关的致痫性肿瘤的临床特征和术后癫痫发作结果，并与单纯性 FCD Ⅰ型和单纯性肿瘤进行比较。特别关注 FCD Ⅲb（与 FCD Ⅰ型相关的肿瘤），其最近被归类为一个独立实体。我们回顾性分析了 1109 例接受药物难治性局灶性癫痫手术的患者的临床资料，其中 492 例患者的组织学诊断为单纯性 FCD Ⅰ型和Ⅱ型（分别为 83 例和 157 例）、单纯性肿瘤（179 例）和 FCD 相关肿瘤（73 例，其中 58 例符合新国际抗癫痫联盟[ILAE]分类的 FCD Ⅲb 标准）。对不同亚组进行了临床特征和术后手术结果评估。伴有肿瘤和 FCD（FCD Ⅲb 和肿瘤相关 FCD Ⅱ）的患者的临床变量和术后癫痫发作结果与单纯性肿瘤患者相似，与单纯性 FCD 患者有显著差异。然而，与单纯性肿瘤相比，FCD 相关肿瘤具有显著的男性优势和更高的癫痫发作频率。继发于单纯性肿瘤或肿瘤相关 FCD 的药物难治性局灶性癫痫患者具有相似的基本临床表现和术后癫痫发作结果。然而，相关 FCD 的致痫作用可能至关重要，需要进行充分评估。FCD 对肿瘤相关癫痫的影响值得进一步研究，以便优化旨在缓解癫痫发作的手术策略。
