Dept. of Epileptology, Medical Center - University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany.
Epilepsy Center Bielefeld, Germany.
Seizure. 2018 Nov;62:66-73. doi: 10.1016/j.seizure.2018.09.021. Epub 2018 Sep 26.
Focal cortical dysplasia (FCD) is the major cause of focal intractable epilepsy in childhood. Here we analyze the factors influencing the success of surgical treatment in a large cohort of children with histologically ascertained FCD.
A retrospective study of the effects of FCD type, surgical intervention, and age at surgery in a pediatric cohort.
A total of 113 patients (71 male; mean age at surgery 10.3 years; range 0-18) were analyzed; 45 had undergone lesionectomy, 42 lobectomy, 18 multi-lobectomy, and eight hemispherotomy. Complete seizure control (Engel Ia) was achieved in 56% after two years, 52% at five years, and 50% at last follow-up (18-204 months). Resections were more extensive in younger patients (40% of the surgeries affecting more than one lobe in patients aged nine years or younger vs. 22% in patients older than nine years). While resections were more limited in older children, their long-term outcome tended to be superior (42% seizure freedom in patients aged nine years or younger vs. 56% in patients older than nine years). The outcome in FCD I was not significantly inferior to that in FCD II.
Our data confirm the long-term efficacy of surgery in children with FCD and epilepsy. An earlier age at surgery within this cohort did not predict a better long-term outcome, but it involved less-tailored surgical approaches. The data suggest that in patients with an unclear extent of the dysplastic area, later resections may offer advantages in terms of the precision of surgical-resection planning.
局灶性皮质发育不良（FCD）是儿童局灶性耐药性癫痫的主要原因。在此，我们分析了在一大群经组织学证实的 FCD 儿童中，影响手术治疗成功的因素。
对儿科队列中 FCD 类型、手术干预和手术时年龄的影响进行回顾性研究。
共分析了 113 例患儿（71 例男性；手术时平均年龄 10.3 岁；范围 0-18 岁）；45 例行病灶切除术，42 例行叶切除术，18 例行多叶切除术，8 例行半脑切除术。术后两年完全控制发作（Engel Ia）的比例为 56%，五年为 52%，最后一次随访（18-204 个月）为 50%。在年龄较小的患者中，切除范围较广（9 岁或以下的患者中有 40%的手术影响了一个以上的脑叶，而 9 岁以上的患者中只有 22%）。虽然大龄儿童的切除范围较小，但他们的长期预后往往更好（9 岁或以下的患者中有 42%无发作，而 9 岁以上的患者中有 56%）。FCD I 的结果并不明显劣于 FCD II。
我们的数据证实了手术治疗 FCD 伴癫痫儿童的长期疗效。在本队列中，手术年龄较早并不预示着更好的长期预后，但手术方法也不太适合。数据表明，对于病变区范围不明确的患者，延迟切除可能在手术切除规划的精确性方面具有优势。
