Early resective surgery causes favorable seizure outcome in malformations of cortical development

• MCDs are developmental abnormalities of brain causing drug-resistant epilepsy.
• They comprise FCDs, hemimegalencephaly, DNET etc.
• We compared the different sub types of MCD and their seizure outcome.
• Complete resection, shorter duration of epilepsy and normal EEG at one-year following surgery predicted good outcome.

PurposeWe analyzed consecutive cases of a large cohort of the spectrum of malformations of cortical development (MCDs) including focal cortical dysplasias (FCDs) who underwent presurgical evaluation through our epilepsy program from January 2000–December 2010. We analyzed factors predicting surgical candidacy, predictors of seizure outcome and reasons for deferring surgery.Methods148 patients with MCD underwent detailed presurgical evaluation and 69 were operated. MCD was diagnosed based on characteristic findings in MRI and re-confirmation by histopathology in operated patients. Post-operative seizure outcome of non-operated and operated patients were assessed every 3 and 12 months and yearly intervals. Multivariate analysis and backward step-wise logistic regression analyzed factors predicting seizure outcome. Kaplan-Meier analysis predicted seizure-free survival rates.Results66.67% patients were seizure-free and aura-free at last follow-up. On multivariate logistic regression, the predictors of seizure freedom in operated MCDs were completeness of resection (odds ratio 8.2; 95% CI 1.43–64.96, p = 0.01), shorter duration of epilepsy (odds ratio 1.19, 95% CI 1.02–1.39, p = 0.02), and absence of spikes in post-operative EEG at one year (odds ratio 4.2; 95% CI 2.52–16.6; p < 0.002). In FCD sub-group, shorter duration of epilepsy (11.1 versus 16.1 years, p = 0.03), absence of secondary generalized seizures (p = 0.05), absence of spikes in post-operative EEG on seventh day (p = 0.009) and one year (p = 0.002) were associated with favorable seizure outcome.ConclusionMajority of patients with MCD and refractory epilepsy when operated early remains seizure-free. Shorter duration of epilepsy is the single most important pre-operative variable and absence of spikes in post-operative EEG, predicts a long-term favorable seizure outcome.