Introduction: Epilepsy surgery for malformations of cortical development (MCD) often requires multiple non-invasive as well as invasive pre-surgical evaluations and innovative surgical strategies. There is limited data regarding surgical management of people with chronic drug resistant epilepsy (DRE) & MCD among the low and middle income countries.
Methods: Presurgical evaluation, surgical strategy and outcome of 53 people who underwent resective surgery for DRE with focal cortical dysplasia between July 2007 and June 2014 were analysed. The surgical outcome was correlated with preoperative clinical, VEEG, MRI, invasive monitoring, surgical findings as well as histopathology and QOLIE-89 scores.
Results: This cohort consists of 19 cases evaluated retrospectively and 34 cases prospectively. Age of onset ranged from 1 to 43 years (mean 9.28yrs; SD 7.25). Duration of epilepsy ranged from 1-39 years (mean 11.68; SD 8.99). The following regional distribution was found; Temporal-31 (Language-13), Frontal-9 (Motor Cortex-5), Parietal-5 (Sensory Cortex-4), Occipital-3 and multilobar-5. Forty seven percent of the cases had FCD in the right hemisphere and 53% had FCD in the left hemisphere. Invasive monitoring was performed for identification of the epileptogenic zone (EZ) as well as eloquent cortex in 7 and intra-operative electro-corticography (ECoG) was used in 32 cases. Histopathology revealed the following distribution; FCD Ia-5, Ib- 2, Ic-4, IIa-6, IIb-10, IIIa-20, IIIb-3, IIId-3. Overall outcome of Engel’s class Ia was 61.3 %. Pre-operative QOLIE-89 score was 26.33-40.17 (mean 33.69, SD 4.35) and post-operative score was 59.21-89.79(mean 73.81; SD 8.29; p=0.04).
Conclusions: Surgical management of people with DRE and FCD is possible in countries with limited resources. Meticulous pre-surgical evaluation to localize epileptogenic zone and complete resection of the focus and lesion can lead to cure or control of epilepsy and improvement in QOL was observed along with seizure-free outcome. The resected tissue can be subjected to proteomic, genomic and metabolomic evaluation through international research collaboration.
Patient Care: My research proves the point that surgery for DRE and FCD can be done with limited resources and achieve outcome at par with the established centers.
Several low and middle income countries can develop innovative and cost effective strategies presented in our epilepsy surgery program.
Learning Objectives: To introduce cost effective and innovative strategies in the pre-surgical evaluation as well as surgical management of people with drug resistant epilepsy and malformations of cortical development in India.
To explore research collaboration with established centers in USA and world-wide in