Surgical outcome and contributing presurgical evaluations in children with magnetic resonance imaging-negative epilepsy and periodic seizure cycles

Yoshihiko Saito; Kenji Sugai; Masaki Iwasaki; Noriko Sato; Akiyoshi Kakita; Yuko Saito; Taisuke Ohtsuki; Masayuki Sasaki

doi:10.1016/j.eplepsyres.2024.107492

Surgical outcome and contributing presurgical evaluations in children with magnetic resonance imaging-negative epilepsy and periodic seizure cycles

Epilepsy Res. 2024 Nov 27:209:107492. doi: 10.1016/j.eplepsyres.2024.107492. Online ahead of print.

Authors

Yoshihiko Saito¹, Kenji Sugai², Masaki Iwasaki³, Noriko Sato⁴, Akiyoshi Kakita⁵, Yuko Saito⁶, Taisuke Ohtsuki⁷, Masayuki Sasaki¹

Affiliations

¹ Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo 187-8551, Japan.
² Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo 187-8551, Japan. Electronic address: sugaikenji4@gmail.com.
³ Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
⁴ Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
⁵ Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan.
⁶ Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
⁷ Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan; Epilepsy Hospital Bethel Japan, Miyagi, Japan.

PMID: 39616860
DOI: 10.1016/j.eplepsyres.2024.107492

Abstract

Background: The identification of surgical candidates is a critical issue in patients with magnetic resonance imaging (MRI)-negative drug-resistant focal epilepsy and latent accompanying resectable lesions, such as focal cortical dysplasia (FCD). Recently, periodic seizure cycles have been associated with FCD in both patients with MRI-positive and MRI-negative epilepsy. We investigated the presurgical evaluation and postsurgical outcome of patients with MRI-negative epilepsy with FCD and a history of periodic seizure cycles.

Methods: We retrospectively reviewed the characteristics of presurgical evaluation and postsurgical seizure outcome in 14 children with MRI-negative drug-resistant focal epilepsy and a history of periodic seizure cycles. All the patients had FCD histopathologically.

Results: The mean age at epilepsy surgery was 7.7 ± 4.7 years (0.7-16.1 years). Favorable postsurgical seizure outcome (ILAE classes 1-3) was obtained in 10 (71 %) patients five years after surgery. The relative risk of the complete concordance between imaging findings and resected area for five-year seizure freedom was 2.25 in positron emission tomography (PET) and 2.22 in subtraction ictal single-photon emission computed tomography co-registered to MRI (SISCOM), and 1.86 in magnetoencephalography (MEG).

Conclusion: All the children with MRI-negative focal epilepsy and a history of periodic seizure cycles were turned out to have FCD pathologically, and are good surgical candidates. Favorable seizure outcome can be expected in such patients when resective epilepsy surgery is planned based on presurgical evaluation with PET or SISCOM.

Keywords: Focal cortical dysplasia; MRI-negative; Periodic seizure cycle; Presurgical evaluation; Surgical outcome.