TY - JOUR
T1 - Surgical resection for intractable epilepsy in "double cortex" syndrome yields inadequate results
AU - Bernasconi, A.
AU - Martinez, V.
AU - Rosa-Neto, P.
AU - D'Agostino, D.
AU - Bernasconi, N.
AU - Berkovic, S.
AU - MacKay, M.
AU - Simon Harvey, A.
AU - Palmini, A.
AU - Costa Da Costa, J.
AU - Paglioli, Eliseu
AU - Kim, H. I.
AU - Connolly, M.
AU - Olivier, A.
AU - Dubeau, F.
AU - Andermann, E.
AU - Guerrini, R.
AU - Whisler, W.
AU - De Toledo-Morrell, L.
AU - Morrell, F.
AU - Andermann, F.
PY - 2001
Y1 - 2001
N2 - Purpose: To analyze the results of surgical treatment of intractable epilepsy in patients with subcortical band heterotopia, or double cortex syndrome, a diffuse neuronal migration disorder. Methods: We studied eight patients (five women) with double cortex syndrome and intractable epilepsy. All had a comprehensive presurgical evaluation including prolonged video-EEG recordings and magnetic resonance imaging (MRI). Results: All patients had partial seizures, with secondary generalization in six of them. Neurologic examination was normal in all. Three were of normal intelligence, and five were mildly retarded. Six patients underwent invasive EEG recordings, three of them with subdural grids and three with stereotactic implanted depth electrodes (SEEG). Although EEG recordings showed multilobar epileptic abnormalities in most patients, regional or focal seizure onset was recorded in all. MRI showed bilateral subcortical band heterotopia, asymmetric in thickness in three. An additional area of cortical thickening in the left frontal lobe was found in one patient. Surgical procedures included multiple subpial transections in two patients, frontal lesionectomy in one, temporal lobectomy with amygdalohippocampectomy in five, and an additional anterior callosotomy in one. Five patients had no significant improvement, two had some improvement, and one was greatly improved. Conclusion: Our results do not support focal surgical removal of epileptogenic tissue in patients with double cortex syndrome, even in the presence of a relatively localized epileptogenic area.
AB - Purpose: To analyze the results of surgical treatment of intractable epilepsy in patients with subcortical band heterotopia, or double cortex syndrome, a diffuse neuronal migration disorder. Methods: We studied eight patients (five women) with double cortex syndrome and intractable epilepsy. All had a comprehensive presurgical evaluation including prolonged video-EEG recordings and magnetic resonance imaging (MRI). Results: All patients had partial seizures, with secondary generalization in six of them. Neurologic examination was normal in all. Three were of normal intelligence, and five were mildly retarded. Six patients underwent invasive EEG recordings, three of them with subdural grids and three with stereotactic implanted depth electrodes (SEEG). Although EEG recordings showed multilobar epileptic abnormalities in most patients, regional or focal seizure onset was recorded in all. MRI showed bilateral subcortical band heterotopia, asymmetric in thickness in three. An additional area of cortical thickening in the left frontal lobe was found in one patient. Surgical procedures included multiple subpial transections in two patients, frontal lesionectomy in one, temporal lobectomy with amygdalohippocampectomy in five, and an additional anterior callosotomy in one. Five patients had no significant improvement, two had some improvement, and one was greatly improved. Conclusion: Our results do not support focal surgical removal of epileptogenic tissue in patients with double cortex syndrome, even in the presence of a relatively localized epileptogenic area.
KW - Double cortex
KW - Intractable epilepsy
KW - MRI
KW - Subcortical band heterotopia
KW - Surgery
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U2 - 10.1046/j.1528-1157.2001.39900.x
DO - 10.1046/j.1528-1157.2001.39900.x
M3 - Article
C2 - 11580758
AN - SCOPUS:0034796808
VL - 42
SP - 1124
EP - 1129
JO - Epilepsia
JF - Epilepsia
SN - 0013-9580
IS - 9
ER -