Focal Cortical Dysplasia and Refractory Epilepsy: Role of Multimodality Imaging and Outcome of Surgery

摘要

The authors performed a retrospective analysis of data from 188 consecutive patients with focal cortical dysplasia and refractory epilepsy with at least 2 years of postsurgery follow-up. Predictors of seizure freedom and the sensitivity of neuroimaging modalities were analyzed. MR imaging showed clear-cut FCD in 136 (72.3%) patients. Interictal FDG-PET showed focal hypo-/hypermetabolism in 144 (76.6%); in 110 patients in whom ictal SPECT was performed, focal hyperperfusion was noted in 77 (70.3%). Focal resection was the most common surgery performed in 112 (59.6%) patients. Histopathology revealed type I FCD in 102 (54.3%) patients. At last follow-up, 124 (66.0%) were seizure-free. Complete resection of FCD and type II FCD were predictors of seizure freedom. Localization of FCD on either MR imaging or PET or ictal SPECT had the highest sensitivity for seizure freedom at 97.5%. They conclude that during presurgical multimodality evaluation, localization of the extent of the epileptogenic zone in at least 2 imaging modalities helps achieve seizure freedom in about two-thirds of patients with refractory epilepsy due to FCD. FDG-PET is the most sensitive imaging modality for seizure freedom, especially in patients with type I FCD.