Electrocorticography in Pediatric Epilepsy Surgery: Comparison between Cortical Dysplasia and Other Etiologies in Relation to Age
Abstract number :
3.194
Submission category :
Year :
2001
Submission ID :
3057
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
S. Koh, MD, Pediatric Neurology, UCLA, Los Angeles, CA; R. Sankar, MD, PhD, Pediatric Neurology, UCLA, Los Angeles, CA; J.Y. Wu, MD, Pediatric Neurology, UCLA, Los Angeles, CA; W.D. Shields, MD, Pediatric Neurology, UCLA, Los Angeles, CA; G.W. Mathern, MD
RATIONALE: Cortical dysplasia (CD) is the leading cause of medically refractory childhood epilepsy that is treated by surgical resection. Age-related electrocorticography (ECoG) patterns in CD and non-CD children were compared.
METHODS: ECoG records of 33 children operated at UCLA between 1999-2001 were reviewed (2 months-15 years; mean 77.7 months). Eighteen had CD and 15 non-CD etiologies. Ten cases opeated at younger than 3 years had CD. ECoGs were reviewed for slowing, attenuation, isolated spikes, runs of spikes (less than 10 seconds), paroxysmal fast activity (PFA) and continuous epileptiform discharges (CEDs, more than 10 seconds). ECoG data were correlated with the age and type of pathology.
RESULTS: Younger CD cases (less than 3 years) had multilobar abnormalities compared with focal lesions in older CD patients. Thus, fewer older CD patients (2/8) had widespread ECoG abnormalities compared with 8/10 younger CD cases. However, the younger CD group demonstrated more CEDs and PFA (5/10) compared with the older CD group (2/8). The 2 youngest CD patients (2 months) also demonstrated burst suppression and multiple, frequent, independent, pleomorphic spikes. Two CD cases had hemimegalencephaly; one (2 months) showed PFA while the other (6 months) exhibited pleomorphic, independent, frequent spikes. Two children had tuberous sclerosis (TS); the youngest (2 years) showed CEDs compared to the older TS patient (10 years) with slowing and attenuation on her ECoG. Furthermore, 4 CD patients had electrographical seizures. All non-CD patients were older than 3 years, had focal findings limited to the area of their abnormalities, and there were no PFA, CEDs, or electrographical seizures.
CONCLUSIONS: Young children with CD show severe ECoG abnormalities such as PFA and CEDs, usually in hemimegalencephaly or TS. Older children, especially non-CD pathology, often have simpler ECoG patterns including attenuation or single spikes. There is a progression with age in CD patients where younger children show more PFA, CEDs, burst suppression, or multiple, independent, frequent, pleomorphic spikes. Such data suggest that ECoG may evolve in CD cases as the brain matures.