Evaluación del tratamiento quirúrgico temprano en lactantes con epilepsias catastróficas asociadas a displasias corticales

Introduction: Cortical dysplasias (CD) can present as catastrophic epilepsy in early infancy, which may have a negative impact in neurological development. The interictal electroencephalogram (EEG), usually shows diffuse or generalized abnormalities that can complicate surgical decisions. Objective: The aim of the study was to describe the EEG findings and surgical outcome of infants with symptomatic catastrophic epilepsy associated with cortical dysplasia. Methods: We retrospectively reviewed EEGs and electronic charts of patients who had diagnosis of cortical dysplasia and underwent epilepsy surgery before the age of 3 years, from 2005 to 2010 in the clinical database of the Epilepsy Comprehensive Center, Children's Medical Center, Dallas, Texas. Results: We found 4/7 girls and 3 /7 boys. The seizure onset was from 0 to 22 months (mean 18 months). The seizure frequency was from 13 to 50 a day (mean 28). We reviewed 24 interictal EEGs, 9/24 showed generalized activity (37.5%) and 15/24 (62%) were focal. We reviewed 9 ictal vEEGs 7/9 were concordant with the lesion (77.7%). The 7 patients underwent intraoperative electrocorticography (ECoG). In 2/7 (28%) chronic invasive monitoring was required. 3/7 (42%) had seizure recurrence, requiring functional hemispherotomy. 6/7 (87%) are currently seizure free, and 1/7 had a 90% seizure reduction. Postsurgically, all patients showed improvement on neurological development. Conclusions: The EEG patterns in infants with catastrophic epilepsy whose epileptogenic focus is associated with cortical dysplasia can be misleading and show generalized epileptiform activity. An early and extensive presurgical evaluation is necessary for a successful surgery associated with a positive neurological development and seizure control outcomes.