AUTHOR=Rácz Attila , Becker Albert J. , Quesada Carlos M. , Borger Valeri , Vatter Hartmut , Surges Rainer , Elger Christian E. 

TITLE=Post-Surgical Outcome and Its Determining Factors in Patients Operated on With Focal Cortical Dysplasia Type II—A Retrospective Monocenter Study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.666056

DOI=10.3389/fneur.2021.666056

ISSN=1664-2295

ABSTRACT=Purpose: Focal cortical dysplasias (FCD) are a frequent cause of drug-resistant focal epilepsies. These lesions are in many cases amenable to epilepsy surgery. We examined 12-months and long-term postsurgical outcomes, and its predictors including positive family history of epilepsy. 
Methods: 12-months and long-term outcomes regarding seizure control after epilepsy surgery in patients operated on with FCD type II between 2002 and 2019 in the Epilepsy Center of Bonn, were evaluated based on patient records and telephone interviews.
Results: Overall 102 patients fulfilled inclusion criteria. At 12 months follow-up (FU) 71%, at the last available FU (63±5.00 months, median 46.5 months) 54% of patients achieved complete seizure freedom (Engel class IA), and 84% and 69% of patients, respectively, displayed Engel class I outcome. From the examined variables (histopathology: FCD IIA versus IIB, lobar lesion location: frontal versus non-frontal, family history for epilepsy, focal to bilateral tonic-clonic seizures (FTBTCS) in the case history, completeness of resection, age at epilepsy onset, age at surgery, duration of epilepsy) outcomes at 12 months were determined by interactions of age at onset, duration of epilepsy, age at surgery, extent of resection and lesion location.  Long-term postsurgical outcome was primarily influenced by extent of resection and the history of FTBTCS. Positive family history for epilepsy had a marginal influence on long-term outcomes only.
Conclusion: Resective epilepsy surgery in patients with FCD II yields very good outcomes both at 12 months and at long-term follow-ups. Complete lesion resection and the absence of FTBTCS prior to surgery are associated with a better outcome.