Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China; Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
Seizure. 2017 Oct;51:133-138. doi: 10.1016/j.seizure.2017.07.008. Epub 2017 Jul 24.
To re-examine drug-resistant epilepsy cases using the revised 2011 ILAE classification of focal cortical dysplasia (FCD).
Patients with drug-resistant epilepsy who have undergone epilepsy surgery in West China Hospital between July 2012 and Jun 2014 were included. Clinical histories, pathological diagnoses, and surgical outcomes were reviewed. A questionnaire was developed to investigate the clinical practice of the new classification. A short-term training program on FCD was carried out to improve pathological diagnosis accuracy.
260 consecutive cases (177 male and 83 female) were included. Pathological diagnosis was changed in 70 cases (26.9%) after re-examination. The five most common pathological types were hippocampal sclerosis (19.2%, 50/260), brain tumors (17.7%, 46/260), vascular malformations (16.2%, 42/260), glial scars (11.2%, 29/260) and FCD (10.0%, 26/260). The most common subtype of isolated FCD was FCD IIb (53.8%, 14/26), followed by FCD IIa (42.3%, 11/26) and FCD Ib (3.8%, 1/26). In addition, forty-five cases were diagnosed as associated FCD type III (17.3%, 45/260). Half of patients with FCD achieved Engel class I at two-year follow-up. Questionnaire investigation suggested most participant pathologists lack sufficient knowledge on the new classification. The diagnostic sensitivity for different FCD subtypes was significantly improved by two to six folds after short-term training.
FCD is an important etiology of drug-resistant epilepsy in western China. It is essential to provide continuing trainings to improve diagnostic precision of FCD in developing countries.
使用修订后的 2011 年国际抗癫痫联盟（ILAE）局灶性皮质发育不良（FCD）分类重新检查耐药性癫痫病例。
纳入 2012 年 7 月至 2014 年 6 月在华西医院接受癫痫手术的耐药性癫痫患者。回顾临床病史、病理诊断和手术结果。制定了一份问卷，以调查新分类的临床实践。开展了 FCD 短期培训计划，以提高病理诊断准确性。
共纳入 260 例连续病例（男 177 例，女 83 例）。70 例（26.9%）经重新检查后病理诊断发生改变。最常见的五种病理类型为海马硬化（19.2%，50/260）、脑肿瘤（17.7%，46/260）、血管畸形（16.2%，42/260）、胶质瘢痕（11.2%，29/260）和 FCD（10.0%，26/260）。孤立性 FCD 最常见的亚型是 FCD IIb（53.8%，14/26），其次是 FCD IIa（42.3%，11/26）和 FCD Ib（3.8%，1/26）。此外，45 例诊断为合并 FCD Ⅲ型（17.3%，45/260）。FCD 患者中有一半在两年随访时达到 Engel Ⅰ级。问卷调查表明，大多数参与病理学家对新分类缺乏足够的认识。短期培训后，不同 FCD 亚型的诊断敏感性提高了两到六倍。
FCD 是中国西部耐药性癫痫的重要病因。为提高发展中国家 FCD 的诊断精度，有必要提供持续培训。
