Epilepsy Surgical Curative Effect In Children Associated With Focal Cortical Dysplasia

[Objective]There are two purposes of this study:(1) The comparison of children withepilepsy caused by focal cortical dysplasia preoperative include with brain magneticresonance (MRI), dynamic video electroencephalogram (VEEG), positron emissioncomputed tomography (PET-CT) and invasive intracranial electroencephalogram fourcheck the accuracy of positioning, select the best combination of checking method;(2)According to The International League Against Epilepsy (ILAE) in2011has alreadydefined FCD clinical type and redefine the clinical pathological subtype classification,we divided the patient into two group (FCD Ⅱ, IIIa for group A, FCDⅠ for group B).Compare the surgical outcomes of the two groups. To evaluated the surgical curativeeffect of children with epilepsy with FCD.[Methods]Part One:30cases of intractable eilepsy in children which were collected fromOctomber，2010to March，2013undergoing in Epilepsy Research and TreatmentCenter of Fuzhou General Hospital were included in this study. According to theinternational union of epilepsy (ILAE) classification method, the removal of brainbiopsy specimens can be divided into groupA (FCD Ⅱ, IIIA)：the relevant type;GroupB (FCDⅠ)： The isolated type. Children with preoperative conventionalcerebral MRI and VEEG, when it is necessary to add do PET-CT and intracranialelectroencephalogram, inspection results compared with surgical outcomes, weobserve the postoperative curative effect.Part Two: A detailed record of two groups of children operation method,postoperative pathological classification, surgical complications.Postoperative caseswere followed up for0.5to1year on a regular basis, understand postoperative seizurecontrol, according to the Engel classification method to evaluate the extent of the surgical outcome.And neuropsychology and AEDs curative effect evaluation,compared with before operation, comprehensive analysis are isolated and related FCDcaused by the surgical curative effect of IE.Statistical software: Data processing using SPSS13.0statistical softwarepackage。Using two independent sample T test and chi-square test methods, whenP<0.05, the statistical is significance.[Results]Part OneGeneral information: There is no obvious difference of the two groups ofchildren in the history of onset age, duration, attack frequency and preoperativemedications.MRI: All30cases of cerebral MRI, including patients of group A with positiverate is78.57%(11/14); patients of Group B with positive rate is37.50%(6/16).Pathological changes of single lobes7cases, multiple lobes in11cases, a total of44detected lesions, all lesions located in the tent of meeting, including20in the righthemisphere: frontal lobes (6), parietal lobes (2),10in the temporal lobe, occipital lobe(2).24in the left hemisphere: frontal lobes (3), parietal lobes (3),15in the temporallobe: occipital lobe (3), the positive rate is56.67%(17/30).PET-CT:13cases (group A:3cases; group B:10cases of cranial MRI negative)role of PET-CT examination, complete PET-CT examination between attack, only2cases of complete episodes PET-CT examination. Show the cerebral blood flowperfusion reduce:4cases, bilateral existence perfusion reduction:6cases, unilateralblood perfusion reduction:3patients, the positive rate was15.38%.VEEG: All30cases of VEEG examination, of which8cases of group A, attackinterphase spike wave discharge mainly in3cases with lateral temporal lobe, attackinterphase spike wave discharge in the anteromedial temporal lobes5cases. Only1case in group B with onset period between spike wave discharge, mainly in thetemporal lobe on the same side. The positive rate was36.67%.Intracranial EEG examination:19cases (group A:6cases, group B:13cases) in children with intracranial EEG examination. During the embedded electrodes, only1case with no obvious attacks,1case with three small attack, more than17casesclinical big attacks are more than1times,3.21times the average attack. According tothe episodes and epilepsy seizures interphase epileptogenic-zone determine sampledischarge is located in the left hemisphere:9cases; the right hemisphere:9cases;Bilateral cerebral hemisphere more focal epilepsy:1case, the positive rate of89.47%.Neuropsychological assessment:30cases do this test. Assessment scaleincludes: son heart scale and the revised wechsler intelligence scale for children(C-WISC) examination. Have different degree of nervous function retardation ofchildren group A:6cases; Group B:10cases. Two groups of children with mental testis more intellectual level within the normal range, but the total intelligence quotient(IQ) in group A were lower than that of group B.Part twoPathology results:30cases diagnosed as children with intractable epilepsypatients with postoperative pathology confirmed FCD ⅠA in2cases, ⅠB in14cases,ⅡAin2cases, ⅡB in2cases, ⅢAin10. Not collected patients with FCDIIIB, C andD.Line mode of operation: A group of children:(1) simple anterior temporal lobehippocampal amygdala excision in10cases;(2) the relevant brain lobe resection ofthe epileptogenic zone in4cases; Group B role of:(1) the relevant brain loberesection of the epileptogenic zone in15cases;(2) the front of the corpus callosumdissection in1case.Surgical complications: Group A: visual field loss in2cases. Group B in thefrontal lobes silence syndrome (1-2weeks fully recover):2cases; visual field loss in2cases. No operative deaths. Comparing the two groups, group A of postoperativevisual field defect in2patients; One case of postoperative memory and get along wellwith others is much better than preoperative. In2cases of group B patientspostoperative visual field defect,2cases of postoperative appear frontal silencesyndrome; One case of postoperative memory deterioration and irritable. Two groupshave no operative death and other continuous nerve dysfunction. Epilepsy control situation(Eagel classes): Group A: EagelⅠ of71.43%(10/14), EagelⅡ of21.43%(3/14), EagelⅢ of7.14%(1/14), EagelⅣ of level0;Group B: EagelⅠ of62.50%(10/16), EagelⅡ of18.75%(3/16), EagelⅢ of6.25%(1/16), EagelⅣ of12.50%(2/16).ADRS usage: In this study were retrospectively compared the two groups ofchildren with preoperative ADRS usage, no obvious difference.Postoperative ADRS,by using two sets of group A were single medicine or two drugs combination therapy,2cases of postoperative6-12months after epilepsy without recrudesce;Prognosis ofgroup A was better than group B.[Conclusions]1．Surgerying is an effective treatment for the focal cortical dysplasia in epilepsy.Early surgical treatment for epilepsy control effect is satisfactory.2． MRI, PET-CT, VEEG and intracranial invasive EEG examination arecombined to the accurate positioning of preoperative lesions has great guidingsignificance. MRI and VEEG examination, especially for preoperative earlier foundFCD lesion has a good effect, but for the two inspection found no obvious lesions ofthe patients, and PET-CT and invasive intracranial EEG examination helpsepileptogenic zone localization.3．According to the statistical data, comprehensive analysis, and there aredifferences in group A and B. FCD Ⅰ type of surgery, with poor prognosis in FCDⅡand FCDIIIa type.4．The prognosis of FCD patients with epilepsy onset age, seizure types,operation method and the relationship between postoperative medications has yet tobe further in-depth study.