Surgical outcomes in children with bottom-of-sulcus dysplasia and drug-resistant epilepsy: a retrospective cohort study

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  • 1 Epilepsy Program, Division of Neurology, Department of Pediatrics;
  • | 2 Neuroscience and Mental Health;
  • | 3 Division of Neurosurgery; and
  • | 4 Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
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OBJECTIVE

Bottom-of-sulcus dysplasia (BOSD) is challenging to identify radiologically. The aim of this study was to explore seizure outcomes after resective surgery or MR-guided laser interstitial thermal therapy (MRgLITT) in children with BOSD.

METHODS

Children with radiologically defined BOSD who underwent resective surgery or MRgLITT, with at least 1 year of follow-up were included. Clinical, radiological, neurophysiological, and histological data were extracted from medical records. Invasive video EEG (IVEEG) was used to evaluate the ictal onset zone or motor/language mapping, wherever appropriate. Histology of MRI-visible BOSD, including the overlying and adjacent cortex, was also evaluated.

RESULTS

Forty-one children with BOSD underwent surgical treatment. The lesion was initially overlooked on MRI in 20 patients (48.8%). Of 34 patients who underwent IVEEG and who had available ictal data, the ictal onset zone extended beyond the MRI-visible BOSD in 23 patients (67.6%). Surgical treatment included lesionectomy (24 patients), extended lesionectomy (12 patients), lobectomy (1 patient), and ablation of BOSD (4 patients). The pathology in 37 patients who underwent resection showed focal cortical dysplasia type IIB and type IIA in 21 (53.8%) and 16 patients (41%), respectively. Seizure freedom was achieved in 32 patients (78.1%) after a mean follow-up of 4.3 years.

CONCLUSIONS

Seizure outcomes after resective surgery or MRgLITT in children with BOSD were generally favorable. The authors found that the neurophysiological abnormality and pathology often extended beyond the MRI-visible BOSD.

ABBREVIATIONS

ASM = antiseizure medication; BOSD = bottom-of-sulcus dysplasia; EKG = electrocardiogram; FCD = focal cortical dysplasia; ILAE = International League Against Epilepsy; IVEEG = invasive VEEG; MEG = magnetoencephalography; MEGSS = MEG spike source; MRgLITT = MR-guided laser interstitial thermal therapy; SEEG = stereo EEG; VEEG = video EEG.

Illustration from Seaman et al. (pp 260–267). Copyright Jane Whitney. Published with permission.

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Contributor Notes

Correspondence Puneet Jain: The Hospital for Sick Children, Toronto, ON, Canada. puneet.jain@sickkids.ca.

INCLUDE WHEN CITING Published online July 2, 2021; DOI: 10.3171/2021.2.PEDS20967.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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