Epileptic Disorders

, Volume 13, Issue 4, pp 422–429 | Cite as

Limited resection of focal cortical dysplasia and associated epileptogenic cortex may lead to positive surgical outcome

  • Kyriakos Garganis
  • Vasileios Kokkinos
  • Basilios Zountsas
Clinical Commentary


A drug-resistant epilepsy patient with premotor type IIb focal cortical dysplasia is described with a positive postoperative outcome following partial resection of the lesion and epileptogenic zone. Presurgical fMRI of the sensorimotor areas showed haemodynamic responses over the posterior border of the lesion and ictal EEG-fMRI revealed activation of both the primary sensorimotor strip and premotor lesion area. Almost continuous 1–2 Hz interictal spiking was recorded during a chronic ECoG study over the primary sensorimotor cortex. Following partial resection of the lesion, an acute ECoG revealed marked reduction of epileptic activity over the sensorimotor area. Post-operatively, seizure control was significantly improved (class IV ILAE outcome). Although partial FCD resections predict a worse postoperative outcome, individual patients may still respond favourably. The type of lesion, resected portion, and histopathology may be included among factors related to successful outcome.


epilepsy surgery intracranial EEG EEG-fMRI fMRI cortical electrical stimulation 


  1. Blümcke I, Thom M, Aronica E, et al. The clinicopathologic spectrum of focal cortical dysplasias: A consensus classification proposed by an ad-hoc Task Force of the ILAE Diagnostic Methods Commission. Epilepsia 2011; 52: 158–174.PubMedCrossRefGoogle Scholar
  2. Boonyapisit K, Najm I, Klem G, et al. Epileptogenicity of focal cortical malformations due to abnormal development: Direct electrocorticographic-histopathologic correlations. Epilepsia 2003; 44: 69–76.PubMedCrossRefGoogle Scholar
  3. Cepeda C, Hurst RS, Flores-Hernadez J, et al. Morphological and electrophysiological characterization of abnormal cell types in pediatric cortical dysplasia. J Neurosci Res 2003; 72: 472–486.PubMedCrossRefGoogle Scholar
  4. Chang E, Wang D, Barkovich J, et al. Predictors of seizure freedomafter surgery for malformations of cortical development. Ann Neurol 2011; 70: 151–162.PubMedCrossRefGoogle Scholar
  5. Chassoux F, Devau B, Landre E, et al. Stereoelectroencephalography in focal cortical dysplasia. A 3D approach to delineating the dysplastic cortex. Brain 2000; 123: 1733–1751.PubMedCrossRefGoogle Scholar
  6. Colombo N, Salamon N, Raybaud C, Ozkara G, Barkovich JA. Imaging of malformations of cortical development. Epileptic Disord 2009; 11: 194–205.PubMedGoogle Scholar
  7. Federico P, Archer JS, Abbott DF, Jackson GD. Cortical/subcortical BOLD changes associated with epileptic discharges. Neurology 2005; 64: 1125–1130.PubMedCrossRefGoogle Scholar
  8. Focke NK, Symms MR, Burdett JL, Duncan JS. Voxel-based analysis of whole brain FLAIR at 3T detects focal cortical dysplasia. Epilepsia 2008; 49: 786–793.PubMedCrossRefGoogle Scholar
  9. Francione S, Nobili L, Cardinale F, Citterio A, Galli C, Tassi L. Intra-lesional stereo-EEG activity in Taylor’s focal cortical dysplasia. Epileptic Disord 2003; 5: 105–114.Google Scholar
  10. Kim DW, Lee SK, Chu KI, et al. Predictors of surgical outcome and pathologic considerations in focal cortical dysplasia. Neurology 2009; 72: 211–216.PubMedCrossRefGoogle Scholar
  11. Krsek P, Pieper T, Karlmeier A, et al. Different presurgical characteristics and seizure outcomes in children with focal cortical dysplasia type I or II. Epilepsia 2009a; 50: 125–137.PubMedCrossRefGoogle Scholar
  12. Krsek P, Maton B, Jayakar P, et al. Incomplete resection of focal cortical dysplasia is the main predictor of poor surgical outcome. Neurology 2009b; 72: 217–223.PubMedCrossRefGoogle Scholar
  13. Lerner JT, Salamon N, Hauptman JS, et al. Assessment and surgical outcomes for mild type I and severe type II cortical dysplasia: A critical review and the UCLA experience. Epilepsia 2009; 50: 1310–1335.PubMedCrossRefGoogle Scholar
  14. Marusic P, Najm I, Ying Z, et al. Focal Cortical Dysplasias in eloquent cortex: Functional characteristics and correlation with MRI and histopathologic findings. Epilepsia 2002; 43: 27–32.PubMedCrossRefGoogle Scholar
  15. Palmini A. Electrophysiology of the focal cortical dysplasias. Epilepsia 2010; 51: 23–26.PubMedCrossRefGoogle Scholar
  16. Palmini A, Gambardella A, Andermann F, et al. Intrinsic epileptogenicity of human dysplastic cortex as suggested by electrocorticography and surgical results. Ann Neurol 1995; 37: 476–487.PubMedCrossRefGoogle Scholar
  17. Palmini A, Najm I, Avanzini G, et al. Terminology and classification of the cortical dysplasias. Neurology 2004; 62: S2–S8.PubMedCrossRefGoogle Scholar
  18. Perry MS, Dunoyer C, Dean P, et al. Predictors of seizure freedom after incomplete resection in children. Neurology 2010; 75: 1448–1453.PubMedCrossRefGoogle Scholar
  19. Sarkis RA, Jehi LA, Bingaman WE, Najm IM. Surgical outcome following resection of rolandic focal cortical dysplasia. Epilepsy Res 2010; 90: 240–247.PubMedCrossRefGoogle Scholar
  20. Tassi L, Colombo N, Garbelli R, et al. Focal cortical dysplasia: Neuropathological subtypes, EEG, neuroimaging and surgical outcome. Brain 2002; 125: 1719–1732.PubMedCrossRefGoogle Scholar
  21. Tyvaert L, Hawco C, Kobayashi E, LeVan P, Dubeau F, Gotman J. Different structures involved during ictal and interictal activity in malformations of cortical development: an EEGfMRI study. Brain 2008; 131: 2042–2060.PubMedCrossRefGoogle Scholar
  22. Urbach H, Scheffler B, Heinrichsmeier T, et al. Focal Cortical Dysplasia of Taylor’s balloon-cell type: a clinicopathological entity with characteristic neuroimaging and histopathological features and favorable post-surgical outcome. Epilepsia 2002; 34: 33–40.CrossRefGoogle Scholar
  23. Widdess-Walsh P, Jeha L, Nair D, Kotagal P, Bingaman W, Najm I. Subdural electrode analysis in focal cortical dysplasia: predictors of surgical outcome. Neurology 2007; 69: 660–667.PubMedCrossRefGoogle Scholar
  24. Woermann FG, Volmar C. Clinical MRI in children and adults with focal epilepsy: A critical review. Epilepsy Behav 2009; 15: 40–49.PubMedCrossRefGoogle Scholar

Copyright information

© John Libbey Eurotext and Springer 2011

Authors and Affiliations

  • Kyriakos Garganis
    • 1
  • Vasileios Kokkinos
    • 1
  • Basilios Zountsas
    • 2
  1. 1.Epilepsy Monitoring Unit“St. Luke’s” HospitalPanorama, ThessalonikiGreece
  2. 2.Neurosurgery Department“St. Luke’s” HospitalThessaloniki, PanoramaGreece

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