Diagnostic methods and treatment options for focal cortical dysplasia.

Détails

ID Serval
serval:BIB_FBACB6F78C11
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Institution
Titre
Diagnostic methods and treatment options for focal cortical dysplasia.
Périodique
Epilepsia
Auteur⸱e⸱s
Guerrini R., Duchowny M., Jayakar P., Krsek P., Kahane P., Tassi L., Melani F., Polster T., Andre V.M., Cepeda C., Krueger D.A., Cross J.H., Spreafico R., Cosottini M., Gotman J., Chassoux F., Ryvlin P., Bartolomei F., Bernasconi A., Stefan H., Miller I., Devaux B., Najm I., Giordano F., Vonck K., Barba C., Blumcke I.
ISSN
1528-1167 (Electronic)
ISSN-L
0013-9580
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
56
Numéro
11
Pages
1669-1686
Langue
anglais
Notes
Publication types: Journal Article ; ReviewPublication Status: ppublishDocument Type: Review
Résumé
Our inability to adequately treat many patients with refractory epilepsy caused by focal cortical dysplasia (FCD), surgical inaccessibility and failures are significant clinical drawbacks. The targeting of physiologic features of epileptogenesis in FCD and colocalizing functionality has enhanced completeness of surgical resection, the main determinant of outcome. Electroencephalography (EEG)-functional magnetic resonance imaging (fMRI) and magnetoencephalography are helpful in guiding electrode implantation and surgical treatment, and high-frequency oscillations help defining the extent of the epileptogenic dysplasia. Ultra high-field MRI has a role in understanding the laminar organization of the cortex, and fluorodeoxyglucose-positron emission tomography (FDG-PET) is highly sensitive for detecting FCD in MRI-negative cases. Multimodal imaging is clinically valuable, either by improving the rate of postoperative seizure freedom or by reducing postoperative deficits. However, there is no level 1 evidence that it improves outcomes. Proof for a specific effect of antiepileptic drugs (AEDs) in FCD is lacking. Pathogenic mutations recently described in mammalian target of rapamycin (mTOR) genes in FCD have yielded important insights into novel treatment options with mTOR inhibitors, which might represent an example of personalized treatment of epilepsy based on the known mechanisms of disease. The ketogenic diet (KD) has been demonstrated to be particularly effective in children with epilepsy caused by structural abnormalities, especially FCD. It attenuates epigenetic chromatin modifications, a master regulator for gene expression and functional adaptation of the cell, thereby modifying disease progression. This could imply lasting benefit of dietary manipulation. Neurostimulation techniques have produced variable clinical outcomes in FCD. In widespread dysplasias, vagus nerve stimulation (VNS) has achieved responder rates >50%; however, the efficacy of noninvasive cranial nerve stimulation modalities such as transcutaneous VNS (tVNS) and noninvasive (nVNS) requires further study. Although review of current strategies underscores the serious shortcomings of treatment-resistant cases, initial evidence from novel approaches suggests that future success is possible.
Pubmed
Web of science
Création de la notice
01/12/2015 18:45
Dernière modification de la notice
20/08/2019 17:26
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