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 ORIGINAL ARTICLE
Year : 2008  |  Volume : 56  |  Issue : 2  |  Page : 138--143

Surgical outcome of cortical dysplasias presenting with chronic intractable epilepsy: A 10-year experience


1 Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
2 Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
3 Department of Neuroradiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
4 Department of Nuclear Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
5 Department of Neuro-pathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India

Correspondence Address:
P Sarat Chandra
Room 705, 7th Floor, Neurosciences Center, All India Institute of Medical Sciences [AIIMS], New Delhi-110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.41990

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Background: There has been sparse description of cortical dysplasias (CDs) causing intractable epilepsy from India. Aim: Clinical retrospective study of CDs causing intractable epilepsy that underwent surgery. Materials and Methods: Fifty-seven cases of CDs reviewed (1995 till July 2006) are presented. All patients had intractable epilepsy, and underwent a complete epilepsy surgery workup (inter ictal electroencephalography (EEG), video EEG, MRI as per epilepsy protocol, SPECT {interictal, ictal with subtraction and co-registration when required}, and PET when necessary). Surgical treatment included a wide exposure of the pathology with a detailed electrocorticography under optimal anesthetic conditions. Mapping of the sensori-motor area was performed where indicated. Procedures included resection either alone or combined with multiple subpial transactions when extending into the eloquent areas. Results: Our study had 28 (49.12%) cases of isolated focal CDs, and 29 (50.67%) with dual pathology. Average age at the time of onset of seizures in our series was 7.04 years (three months to 24 years), and average age at the time of surgery was 10.97 years (eight months to 45 years). Among coexistent pathologies, one had associated MTS, 16 had coexistent gangliogliomas and 12 (dysembryonic neuroepithelial tumor) DNTs. At an average follow-up of 3.035 years (range 5-10 years), three patients were lost to follow-up. Fifty-one per cent (29/57) patients had a good outcome (Engel Grade I) and 26%(15/57) had a Grade II outcome. Conclusion: Cortical dysplasias have a good outcome if evaluated and managed with concordant electrical and imaging modalities.






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