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Neurophysiologic Findings of Neuronal Migration Disorders: Intrinsic Epileptogenicity of Focal Cortical Dysplasia on Electroencephalography, Electrocorticography, and Magnetoencephalography

Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada, hiroshi.otsubo{at}sickkids.ca.

Koji Iida, MD, PhD

Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada

Makoto Oishi, MD, PhD

Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada

Chiyuki Okuda, MD, PhD

Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada

Ayako Ochi, MD, PhD

Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada

Elizabeth Pang, PhD

Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada

Shelly K. Weiss, MD, PhD

Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada

James T. Rutka, MD, PhD

Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada

Sylvester H. Chuang, MD

Division of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada

O. Carter Snead, III, MD

Division of Neurology, The Hospital for Sick Children

We define specific neurophysiologic characteristics for focal cortical dysplasia, a neuronal migration disorder. We reviewed data from published reports and our patients with focal cortical dysplasia. Our patients underwent preoperative scalp video-electroencephalography (EEG), magnetic resonance imaging (MRI), magnetoencephalography, and intraoperative or extraoperative electrocorticography monitoring. Scalp EEG showed trains of rhythmic epileptiform spike or sharp waves. Positive spikes correlated with early seizure onset, MRI lesion around the rolandic fissure, hemiparesis, and a less favorable outcome. Interictal electrocorticography showed continuous epileptogenic discharges: repetitive electrographic seizures and bursting discharges or continuous or quasicontinuous rhythmic spiking. Ictal electrocorticography showed paroxysmal fast and/or repetitive spiking. Magnetoencephalography showed clustered spike sources within and extending from the lesion. Cortical stimulation gave more frequent, lower-threshold afterdischarges and higher-threshold primary motor function. Focal cortical dysplasias are highly and intrinsically epileptogenic. For surgical seizure control, EEG, electrocorticography, and magnetoencephalography must delineate the intrinsic epileptogenic zone within and extending from the focal cortical dysplasia identified by MRI. (J Child Neurol 2005;20:357—363).

Journal of Child Neurology, Vol. 20, No. 4, 357-363 (2005)
DOI: 10.1177/08830738050200041501


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