Focal Cortical Dysplasia Clinical Features And Treatment(Two Cases Report And Literature Review)

Focal cortical dysplasia (FCD) is one of the malformations of cortical development (MCD), and is the most common cause of intractable epilepsy in children, the second of the third cause in adult. Because lots of intractable epilepsy is defined cryptogenic epilepsy, the real incidence of the FCD perhaps is underestimated. Since1971, the first report of FCD by David Taylor et al, the classification, diagnosis, treatment of FCD has been developed.ObjectivesFocal cortical dysplasia (FCD) is rare but has been increasingly reported since its discovery. We present two cases of FCD, surgery treated with good outcome in our hospital. And we reviewed literature of FCD, analyzed the epidemiology, clinical presentation, diagnosis and surgery outcome of this disorder.MethodsWe present two FCD patients under surgery with clinical presentation, surgery procedures, and follow ups. We performed a literature search for FCD in online databases using the key words Focal cortical dysplasia, FCD and analyzed the epidemiology, clinical presentation, diagnosis and surgery outcome of this disorder, thought it would be helpful for the future investigation and clinical research. The FCD classification we used here, if not otherwise specified, is Palmini FCD classification. The main characteristics of FCD are loss of the normal cortical laminar architecture and organization. Without any other features, this constellation is classified as type Ⅰ. Type Ⅱ cortical dysplasia includes the cortical abnormalities along with finding dysmorphic neurons (FCD ⅡA) and balloon cells (FCD ⅡB). Under the new ILAE classification patients with FCD type Ⅲ have type Ⅰ cortical dysplasia in association with other epileptogenic lesions, such as hippocampal sclerosis (FCD type3a), epilepsy-associated tumors (FCD type3b), adjacent vascular malformations (FCD type3c), and other acquired epileptogenic lesions (FCD Type3d).Fisher exact test two-tailed was use for statistical comparisons and P<0.05is considered to be stastisticly significant.Results and conclusionsWe present two cases of intractable epilepsy; the pathology of both after surgery was turned out to be ILAE FCD Ⅱb. The lesions of the two cases both located in the frontal lobe with positive MRI results, case1is near the motor zone and case2is adjacent to the Broca zone. Both cases had good surgery outcomes, there were no function deficit, no seizure recurrent, and are class Ⅰ by Engel.We reviewed the literature of the FCD, analyzed and concluded as follow:The most common manifestation of FCD is medication resistant epilepsy. There are quite a proportion of patients under surgery for intractable epilepsy turning out to be FCD; FCD is more common in boys than in girls; the type Ⅰ FCD is more likely localized in temporal lobe; the MRI positive rate is high, but not specific; the outcome of surgery is promising and the prognosis of surgery is depended on the type, the localization of the foci and clinical presentations; and the surgery is the earlier the better.