Challenges in managing epilepsy associated with focal cortical dysplasia in children.

Lily C Wong-Kisiel, Thomas Blauwblomme, Mai-Lan Ho, Nathalie Boddaert, Joseph Parisi, Elaine Wirrell, Rima Nabbout

Journal: Epilepsy research 2019;145():1-17

PMID: 29803953

Full Text on Elsevier Science View on PubMed

Abstract

Focal cortical dysplasia (FCD) is the most common cause of intractable focal epilepsy in children, in whom seizures are most commonly pharmacoresistant from onset. This review summarizes the current understandings of the epidemiology, natural history, and the proposed mechanisms of epileptogenisis in FCD. Advances in neuroimaging techniques have enhanced the recognition of this pathology, which can be subtle. Illustrative neurophysiology and imaging examples are provided to help the clinicians identify diagnostic evidence of suspected FCD. Given the refractory course to pharmacologic management, alternative options such as ketogenic diet, resective surgery or neuromodulation can be considered. Recognition of FCD pathology in children with early onset epilepsy should prompt timely evaluations for resective surgery, which may render a significant number of patients seizure-free and improve neurocognitive outcome.

Address: Department of Neurology, Mayo Clinic, 200 First St., SW, Rochester, MN, 55905, USA. Electronic address: [email protected].; Department of Pediatric Neurosurgery, Hôpital Necker, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 149 rue de Sevres, 75015, Paris, France. Electronic address: [email protected].; Department of Radiology, Mayo Clinic,200 First St., SW, Rochester, MN, 55905, USA. Electronic address: [email protected].; Department of Pediatric Radiology, Hôpital Necker, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 149 rue de Sevres, 75015, Paris, France. Electronic address: [email protected].; Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St., SW, Rochester, MN, USA. Electronic address: [email protected].; Department of Neurology, Mayo Clinic, 200 First St., SW, Rochester, MN, 55905, USA. Electronic address: [email protected].; Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris Cité, 149 rue de Sevres, 75015, Paris, France; INSERM U1129, Paris Descartes University, CEA, Gif sur Yvette, France. Electronic address: [email protected].

DOI: 10.1016/j.eplepsyres.2018.05.006

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MeSH Terms: Child, Cognition Disorders, Disease Management, Epilepsy, Humans, Malformations of Cortical Development, Group I