Application of multimodal epilepsy assessment system in focal cortical dysplasia-related epilepsy / 第二军医大学学报

ABSTRACT

Objective: To propose a multimodal epilepsy assessment system to guide the surgical treatment of patients with focal cortical dysplasia (FCD)-related epilepsy, and to explore its significance in improving the prognosis of patients with FCD-related epilepsy. Methods: Twenty-two epilepsy patients with FCD confirmed by postoperative pathology, who underwent surgical treatment at Second Hospital of Lanzhou University from Oct. 2016 to Nov. 2018, were enrolled. All patients were evaluated by multimodal epilepsy assessment system during the perioperative period. The assessment techniques included onset symptom assessment, structural imaging, long-term scalp video electroencephalogram monitoring, positron emission tomography-computed tomography, image fusion analysis, and magnetic resonance imaging (MRI). Engel efficacy grading system was used to assess the prognosis. Engel I grade was defined as good control for epilepsy and Engel II to IV as poor control. Fisher exact test was used to explore the influences of gender, age, pathological type, MRI examination, lesion location, duration of disease, and electroencephalogram-clinical characteristic-anatomical localization consistency on the prognosis of patients. Results: Twenty-two patients (13 males and 9 females) underwent surgical resection of the lesions, and were followed up for 4 to 28 months. There were 18 cases of Engel I grade, 2 cases of Engel II grade, 1 case of Engel III grade, and 1 case of Engel IV grade, with the good control rate being 81.8% (18/22). Fisher exact test analysis showed that disease duration and electroencephalogram-clinical characteristic-anatomical localization consistency were independent factors of efficacy of FCD-related epilepsy (P = 0.045 and 0.005). While age, lesion location, gender, pathological type and MRI findings had no significant effect on prognosis (all P < 0.05). Conclusion: The multimodal epilepsy assessment system can more accurately locate epileptogenic foci of patients with FCD-related epilepsy, providing a theoretical basis for epilepsy surgery. It is a comprehensive and accurate assessment method for epileptogenic foci.