Management of epilepsy caused by focal cortical dysplasia

The incidence of Focal Cortical Dysplasia (FCD) is almost ۵۰% of all the cases of intractable epilepsy identified in adults and children. Antiepileptic drugs (AEDs) have been widely used in the treatment of FCD. However, evidence to suggest their specific effect in the treatment of FCD remains to be established. Although treatment currently involves surgical management, noninvasive treatments have been identified. non-invasive management strategies including, ۱-mammalian target of rapamycin (MTOR)inhibitors, ۲- ketogenic diet (KD), and ۳- vagus nerve stimulation (VNS). Commonly used drugs in the treatment of drug-resistant epilepsy are broad spectrum AEDs such as levetiracetam, topiramate, and zonisamide for their multiple mechanisms of action. Epileptic seizures in focal cortical dysplasia are difficult to control with pharmacological treatment and often intractable. Hence, the surgical treatment appears to be a next therapeutic procedure. The resection of lesion, lobectomies and even hemispherectomies are performed. More limited surgeries are performed in elderly patients, usually due to FCD type I, usually located within the temporal lobe. Younger patients usually have FCD type II, with more extensive lesions and extratemporal location, predominantly in the frontal areas. In these cases operation includes lobectomy/ies or even hemispherectomy. According to the literature, ۶۰–۸۰% of patients remain seizure-free after surgery, depending on the study center.