SPONTANEOUS REMISSION OF CHILDHOOD EPILEPSY IN 2 PATIENTS WITH FOCAL EXTRAOPERCULAR CORTICAL DYSPLASIA

Childhood-onset partial epilepsy caused by focal cortical dysplastic l esions (FCDLs) is often severe. A few patients reported with a favorab le outcome had a normal neuropsychological examination, and FCDLs were always localized around the opercular region, suggesting that extent and location of the lesion may account for the favorable outcome. We r eport two patients with extraopercular FCDLs, who had a spontaneous re mission of their childhood-onset epilepsy, despite a severe neurologic al deficit. A 22-year-old girl (patient 1) and a 16-year-old boy (pati ent 2), began to have partial seizures at the age of 9 years and 1 yea r respectively. On neurological examination, patient 1 had left hemipa resis and patient 2 had low IQ. Interictal EEG recordings revealed rep etitive epileptiform discharges involving the right temporo-parietal o r frontal areas in patients 1 and 2 respectively. MRI study showed foc al cortical thickening or abnormal gyration located over the right par ietal and frontal region respectively in patients 1 and 2, but failed to evidence T2 prolongation in the white matter beneath the dysplastic cortex. Optimal antiepileptic regimen always stopped seizures. Their long-term course was favorable, with remission of the seizures and nor malization of EEG recordings, even 4-5 years after medication withdraw al. In conclusion, FCDLs may cause epilepsy with a benign course even in patient with mental retardation or neurological abnormalities, This may be related to a morphologically milder dysplastic lesion than fou nd in patients with FCDLs and severe epilepsy. (C) 1997 Elsevier Scien ce B.V.