Clinical analysis on 22 patients with childhood and juvenile epilepsy related focal cortical dysplasia

Abstract

Background Focal cortical dysplasia (FCD) is a group of diseases including abnormal cortical layer, abnormal cell structure and abnormal white matter. It is one of the main causes of intractable epilepsy. In this paper, the clinical manifestations, EEG and MRI characteristics of FCD in children and adolescents were summarized in order to improve the diagnosis and treatment level of clinicians.  Methods The clinical symptoms, EEG and MRI manifestations of 22 cases were retrospectively analyzed.  Results Among 22 cases, 13 cases (59.09%) only showed focal seizures, 6 cases (27.27%) only showed generalized seizures, and 3 cases (13.64%) showed focal to generalized seizures. The seizure frequency of 22 patients was namely: 6 cases (27.27%) had seizures daily, 13 cases (59.09%) were more than one time/month, and 3 cases (13.64% ) were less than one time/month. EEG in 21 cases (95.45% ) showed abnormal slow waves and epileptiform discharges. MRI of 12 cases showed FCD infrontal lobe, the scalp EEG of whom showed abnormal slow waves and epileptiform discharges in focal frontal region in 7 cases (7/12), extensive slow waves and spike and slow wave complex in 2 cases (2/12), temporal sharp waves in 2 cases (2/12), and a small amount of sharp waves at midline in one case (1/12). Simple focal seizures occurred in 7 cases (7/12), generalized seizures occurred in 4 cases (4/12), and focal to generalized seizures occurred in one case (1/12). MRI of 6 cases showed FCD in parietal lobe, the scalp EEG of whom showed abnormal slow waves and epileptiform discharges in focal parietal region in 3 cases (3/ 6), epileptiform discharges in temporo-occipital region in 2 cases (2/6), and no abnormality in one case (1/6). Simple focal seizures occurred in 5 cases (5/6), and focal to generalized seizures occurred in one case (1/6). MRI of 2 cases showed FCD in temporal lobe, the scalp EEG of whom showed abnormal slow waves and epileptiform discharges in focal temporal region in one case (1/2) and epileptiform discharges in frontal region in one case (1/2). Generalized seizures occurred in those 2 cases. MRI of 2 cases showed FCD in insular lobe, the scalp EEG of whom showed epileptiform discharges in bilateral temporal regions in one case (1/2) and sharp waves and sharp and slow wave complex of all lead in one case (1/2). Simple ocal seizures occurred in one case (1/2) and focal to generalized seizures occurred in one case (1/2).  Conclusions FCD mostly occurs in preschool and school ge. Epileptic seizures are focal or generalized, other seizure type can also be seen, and the frequency is high. Head MRI is an important method for diagnosing FCD. Antiepileptic drugs (AEDs) therapy is mostly used to control epileptic seizures. Epilepsy surgeries should be considered if the curative effect of AEDs is poor.

DOI: 10.3969/j.issn.1672-6731.2018.06.006