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Clinical Characteristics of Focal Cortical Dysplasia_ Correlation


									Clinical Characteristics of Focal Cortical
Dysplasia: Correlation with Pathological
Peter Widdess-Walsh1, Richard Prayson2, William Bingaman3, Imad Najm1

Department of Neurology1, Anatomic Pathology2, and Neurosurgery3

Cleveland Clinic Foundation.


Purpose: Focal cortical dysplasia (CD) is a common cause of pharmacoresistant epilepsy
that is amenable to surgical resection. CD is due to abnormalities in neuronal migration,
proliferation, and/or differentiation that result in distinct pathological subtypes, termed
1A, 1B, 2A, and 2B. In this study, we retrospectively reviewed and compared the
electroclinical and imaging characteristics of the pathological subtypes of CD.

Methods: We retrospectively reviewed patient data from epilepsy surgeries at the

Cleveland Clinic Foundation between 1990 and 2002. Only those patients with the

definite pathological diagnosis of isolated cortical dysplasia were included in the study

(n=120). Thirty-seven patients with dual pathology (FCD with hippocampal sclerosis)

were also analyzed separately. Patient demographics, risk factors, results of video-EEG

evaluations, MRI findings, and postsurgical outcomes were reviewed and analyzed.

Results: Balloon cell (BC) containing lesions were found in 25 patients (21%) and were

mainly localized to the fronto-central area. Patients with BC containing CD had: earlier

age of onset of epilepsy and pharmacoresistance, higher incidence of perinatal

complications, more frequent seizures, more prominent FLAIR MRI abnormalities, more
severe impairment in their neuropsychological function, required more invasive

evaluations, and were operated on at a younger age. They showed a favorable

postoperative seizure outcome, unless an invasive evaluation was required. Multivariate

analysis of postoperative outcomes showed that the presence of balloon cells and a non-

frontal location of the epileptogenic zone predicted a good outcome.

Conclusions: BC containing cortical dysplasia may represent a distinct pathological and

clinical entity. Correlative immunohistochemical studies of balloon cells provide insight

into the underlying pathophysiological mechanisms of epileptogenesis and will be


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