Outcomes of Predrug Resistant Versus Postdrug Resistant Surgery in Children With Focal Cortical Dysplasia-Related Epilepsy: Drug Resistance Should Not Be the Threshold for Surgical Candidacy.

BACKGROUND

Surgical intervention has become an established treatment option for epilepsy, but its traditional indications are limited to drug resistant cases. This study compares outcomes of early surgery (predrug resistance) with traditional surgery (postdrug resistance) in focal cortical dysplasia (FCD)-related epilepsy, providing clinical evidence for early surgical intervention.

METHODS

Medical records of FCD-related epilepsy children who underwent 1.5 T or 3T brain magnetic resonance imaging at our center (Jan 2008-Dec 2022) were reviewed. Children were divided into early surgery and traditional surgery groups based on treatment pathway. Postoperative seizure outcomes, antiseizure medication (ASM) outcomes, seizure duration, and ASM usage were compared.

RESULTS

Of the 195 children with magnetic resonance imaging-confirmed FCD who met the inclusion criteria, 167 (85.6%) were diagnosed with FCD-related epilepsy. Median follow-up duration was 61 months. Twenty-eight (16.7%) achieved seizure freedom with the first ASM, while 5.6% and 5.4% achieved seizure freedom with the second and third or more ASMs, respectively. Ninety-nine children received surgical treatment, with 45 undergoing early surgery and 54 receiving traditional surgery. At the last follow-up, significantly more children in the early surgery group (88.9%) achieved seizure freedom compared to the traditional surgery group (74.1%) (P = 0.033).

CONCLUSIONS

Early surgical evaluation can help identify candidates who may benefit from early surgery while maintaining comparable perioperative risks to traditional surgery. Therefore, it is necessary to refine the timing and criteria for epilepsy surgery evaluation. For patients with noneloquent cortical brain lesions, early surgery is recommended to reduce the duration of living with seizure.