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

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dc.contributor.authorRadhakrishnan, A
dc.contributor.authorMenon, R
dc.contributor.authorMenon, D
dc.contributor.authorSingh, A
dc.contributor.authorRadhakrishnan, N
dc.contributor.authorVilanilam, G
dc.contributor.authorAbraham, M
dc.contributor.authorThomas, B
dc.contributor.authorKesavadas, C
dc.contributor.authorVarma, RP
dc.contributor.authorThomas, SV
dc.date.accessioned2017-03-10T03:26:22Z
dc.date.available2017-03-10T03:26:22Z
dc.date.issued2016
dc.description.abstractPurpose: We 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. Methods: 148 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. Results: 66.67% 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. Conclusion: Majority 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. (c) 2016 Elsevier B.V. All rights reserved.
dc.identifier.citation124 ,;1-11en_US
dc.identifier.uri10.1016/j.eplepsyres.2016.04.006
dc.identifier.urihttps://dspace.sctimst.ac.in/handle/123456789/9622
dc.publisherEPILEPSY RESEARCH
dc.subjectNeurosciences & Neurology
dc.titleEarly resective surgery causes favorable seizure outcome in malformations of cortical development
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