Prognostic analysis in children with focal cortical dysplasia II undergoing epilepsy surgery: Clinical and radiological factors

Siqi Zhang; Yi Luo; Yilin Zhao; Fengjun Zhu; Xianping Jiang; Xiaoyu Wang; Tong Mo; Hongwu Zeng

doi:10.3389/fneur.2023.1123429

Prognostic analysis in children with focal cortical dysplasia II undergoing epilepsy surgery: Clinical and radiological factors

Front Neurol. 2023 Mar 6:14:1123429. doi: 10.3389/fneur.2023.1123429. eCollection 2023.

Authors

Siqi Zhang^{1

2}, Yi Luo^{1

2}, Yilin Zhao², Fengjun Zhu³, Xianping Jiang⁴, Xiaoyu Wang², Tong Mo², Hongwu Zeng²

Affiliations

¹ Shantou University Medical College, Shantou University, Shantou, China.
² Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China.
³ Department of Epilepsy Surgical Department, Shenzhen Children's Hospital, Shenzhen, China.
⁴ Department of Pathology, Shenzhen Children's Hospital, Shenzhen, China.

Abstract

Objective: The aim of this study was to investigate the value of clinical profiles and radiological findings in assessing postsurgical outcomes in children with focal cortical dysplasia (FCD) II while exploring prognostic predictors of this disease.

Methods: We retrospectively reviewed 50 patients with postoperative pathologically confirmed FCD II from January 2016 to June 2021. The clinical profiles and preoperative radiological findings were measured and analyzed. The patients were classified into four classes based on the Engel Class Outcome System at the last follow-up. For the analysis, the patients were divided into two categories based on Engel I and Engel II-IV, namely, seizure-free and non-seizure-free groups. Qualitative and quantitative factors were subsequently compared by groups using comparative statistics. Receiver operating characteristic (ROC) curves were used to identify the predictors of prognosis in children with FCD II.

Results: Thirty-seven patients (74%) had Engel class I outcomes. The minimum postsurgical follow-up was 1 year. At the epilepsy onset, patients who attained seizure freedom were older and less likely to have no apparent lesions on the preoperative MRI ("MRI-negative"). The non-seizure-free group exhibited a higher gray matter signal intensity ratio (GR) on 3D T1-MPRAGE images (p = 0.006), with a lower GR on T2WI images (p = 0.003) and FLAIR images (p = 0.032). The ROC curve indicated that the model that combined the GR value of all MRI sequences (AUC, 0.87; 95% CI, 0.77-0.97; p < 0.001; 86% sensitivity, 85% specificity) was able to predict prognosis accurately.

Conclusion: A lower age at the onset or the MRI-negative finding of FCD lesions suggests a poor prognosis for children with FCD II. The model consisting of GR values from three MRI sequences facilitates the prognostic assessment of FCD II patients with subtle MRI abnormalities to prevent worse outcomes.

Keywords: focal cortical dysplasia; pediatrics; predictors; prognosis; radiological findings.

Grants and funding

This study was supported by the Natural Science Foundation of Guangdong Province (No. 2022A1515011427), the Sanming Project of Medicine in Shenzhen (SZSM202011005) from Shenzhen Medical and Health Project, the Guangdong High-level Hospital Construction Fund (ynkt2021-zz47), and the Shenzhen Science and Technology Plan Project (No. JCYJ20180228175305397).