Seizure freedom after surgical resection in a child with focal cortical dysplasia type IIIB

AIM: In approximately 30% of patients with epilepsy pharmacological treatment is ineffective. Focal cortical dysplasia (FCD), a congenital abnormality of cortical development, is among the most common etiologies of intractable epilepsy (IE) in the pediatric population. Epilepsy surgery offers the potential to render these patients seizure free, reduce antiepileptic medication as well as their associated side effects and improve their cognitive outcome. However, FCD is one of the most challenging lesions to identify on imaging and successful outcomes in epilepsy surgery, are in part dependent upon identification of a lesion on Magnetic Resonance Imaging (MRI). We report a case of an 11 years old girl with IE due to FCD type IIIb, which is after surgical treatment seizure free. MATERIALS AND METHODS: Our patient has been suffering from epilepsy since her early infancy. Her attacks were partial with complex symptomatology and occasional generalization. She had focal changes in the EEG in the right centrotemporal region. Three brain MRI were described as normal. In December of 2016, her attacks have intensified. Despite the combination of five antiepileptics, she had sometimes more than one hundred attacks per day. On the fourth brain MRI, in February 2017, FCD was suspected in the precentral and postcentral gyrus of the right hemisphere. Soon after, she was operated and pathohistological diagnosis of resected tissue was FCD type IIIb (cortical lamination abnormalities adjacent to ganglioglioma). RESULTS: Postoperatively she developed a hemiplegia, but now after 1.5 year of physical therapy she has only a mild hemiplegia and she is completely seizure free with only one antiepileptic drug- levetiracetam. Her cognitive abilities are preserved and she finished the third grade of elementary school with excellent success. CONCLUSION: Despite the diversity of medicamentous antiepileptic therapy, in well-chosen patients, a surgical procedure can have a life-changing effect.