Treatment results for drug-resistant epilepsy with polymicrogyria

Abstract

Polymicrogyria (PMG) is a malformation of cortical development (MCD) and is
classified as an ICD secondary to abnormal post-migration neuronal development [[1], [2], [3],
[4]]. In addition to the spectrum of neurological diseases, 65–87% of patients with PMG develop
epilepsy, and most experience seizures within the first five years of life [1]. Approximately 65%
of patients with PMG-associated epilepsy have drug-resistant epilepsy (DRE). Epilepsy surgery
should be considered in these patients with DRE associated with PMG [1,5,6]. Although epilepsy
surgery has been shown to be superior to continuous anticonvulsant medication alone for seizure
control in a subset of appropriately selected patients with EMH-associated ED [[7], [8], [9]], only
5% of all MCI-associated epilepsy surgeries target EMH-associated epilepsy [10]. The complexity
of surgery in these patients reflects the presence of extensive (sometimes bilateral) brain
malformations in many cases, and the fact that the EMH cortex typically maintains normal brain
function [[1], [11]]. Given these concerns, healthcare providers may choose not to perform surgery
in this particular group of patients with EMH, and thus surgery is underutilized or delayed [10]