[Clinical characteristics, surgical treatment and prognosis of rolandic and perirolandic drug-resistant epilepsies].

Objective: To explore the clinical characteristics, treatment strategies and prognosis of rolandic and perirolandic drug-resistant epilepsies (DREs). Methods: The clinical data of 53 patients diagnosed with rolandic or perirolandic DRE who were admitted to Epilepsy Center, Sanbo Brain Hospital of Capital Medical University from January 2008 to January 2019 were retrospectively analyzed. The patients were divided into resective therapy group and non-resective therapy group [bipolar electrocoagulation on cortex, stereotactic electroencephalography (SEEG)-guided radiofrequency thermocoagulation, and vagus nerve stimulation]. The outcomes of epilepsy and post-surgical limb function were compared and analyzed. Results: A total of 53 patients were included, aged from 3 to 45 years old [(19±11) years], with 33 males and 20 females. Thirty patients received resective therapy and 23 patients received non-resective therapy. The curative effect of the resective therapy group was significantly better than that of the non-resective therapy group. The rate of Engel Ⅰ in resective therapy group was higher than that of non-resective group [83.3% (25/30) vs 39.1% (9/23), P=0.011). Compared with the non-resective group, the incidence of muscle strength decline in the resective group was higher both at 1 week [73.3% (22/30) vs 21.7% (5/23), P=0.006] and 3 months [30% (9/30) vs 0, P=0.016] after surgery. Conclusions: During the diagnosis and treatment, the multimodal method is conducive to the qualitative and localized diagnosis of the rolandic or perirolandic epilepsy, while SEEG has important value in the diagnosis, functional localization and treatment of the disease. Resective therapy is still the most effective method to terminate epilepsy, but it has a higher risk of post-surgical dysfunction.

[Neuropathologic findings in intractable epilepsy: a clinicopathologic analysis of 822 cases].

Objective: To investigate the clinicopathologic characteristics of intractable epilepsy. Methods: Based on the classification criteria proposed by the International League Against Epilepsy (ILAE), a retrospective analysis of the pathological characteristics was done in 822 patients who underwent epilepsy surgery in Sanbo Brain Hospital, Capital Medical University, from June 2008 to December 2012. Results: The mean age of epilepsy onset was 9.9 years, mean duration of epilepsy was 11.9 years. Complex partial seizures were the main presenting features. Histopathological study showed 33 cases (4.01%) with mild forms of cortical malformations, 690 cases (83.94%) with focal cortical dysplasia (FCD) and 99 cases with others (including 39 pure hippocampal sclerosis, 20 cystosclerosis, 19 Sturge-Weber syndrome, 8 tuberous sclerosis complex, 6 without significant pathological changes, 5 gyral malformations and 2 hamartoma). Among the 690 FCD cases, 106 were FCD typeⅠ, 91 were FCD typeⅡ and 493 were FCDⅢ(Ⅲa: 160, Ⅲb: 106, Ⅲc: 26 and Ⅲd: 201). Conclusions: FCDⅢd is the most common histopathological subtype causing intractable epilepsy, mainly due to focal hypoxia/ischemia in the perinatal period, which results in scarring of local brain tissue; this is followed by other isolated forms of FCD (FCDⅠand FCDⅡ), and then FCD Ⅲa and FCD Ⅲb. The reason to distinguish isolated forms of FCD (types Ⅰ and Ⅱ) from FCD Ⅲ and to subclassify FCD Ⅲ is to allow better definition of cortical dyslamination. Therefore, the pathogenic factors of intractable epilepsy can be grouped in greater details, and facilitate the diagnosis and potential curative treatment of intractable epilepsy.