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Posted By CCF neuro MD MM on October 19, 1998 at 17:22:38:

In Reply to: CORTICAL DYSPLASIA posted by Toni Kerce on October 19, 1998 at 15:59:59:

: My 6 year old son has recently been diagnosed with cortical dysplasia.  The EEG Report showed abnormal in waking and sleep due to asymmetric driving during photic stimulation (EEG did not show 3-per-second spike-and-wave discharges/ruled out petit-mal seizures, but can not exclude complex partial seizures).  The MRI report was as follows: FINDINGS: No signal abnormality is identified within the brain.  Myelination is appropriate for age.  There is asymmetric gyral formation in the paramedian parieto-occipital lobes with a prominent and questionable thickened gyrue on the right.  No other morphologic abnormalities are identified.  No mass lesions or areas of edema are seen.  The hippocampi are normal in appearance.  The ventricles, cisterns and sulci are normal flow voids.  The paranasal sinuses, mastoid air cells, and middle ears are well aerated except for several areas of minimal mucosal thickening.  IMPRESSION: Gyral asymmetry in the paramedian parieto-occipital lobes with prominent gyrus on the right.
: My son displays the following symptoms: delayed speech, does not speak in full sentences/leaving out connective vocabulary,  repeating questions frequently, problems with fine motor skills/handwriting, migraines, "overexaggerated episodes of staring" since age 2 or 3, and is immature for his age.  During these staring episodes it extremely hard to get my son's attention, and when you do he does not have a clue as to what has gone on or is going on.  My son reads very well.  I have had one pediatric neurologist tell me and my husband that the Cortical Dysplasia could not possibly cause the problems which he is having, that he needed to be checked for ADD and that we needed to have his vision checked often.  We went for a second opinion with a pediatric neurologist who is very well respected in the Atlanta area, where we live, and he says that he believes the problems my son is having is definately related to the cortical dysplasia and possibly complex partial seizures which could be caused by cortical dysplasia.
: Please help me, as I would like to know the answers the following questions, as this has been most frustrating in finding any information regarding cortical dysplasia: 1) Can cortical dysplasia cause the problems my son is having?  2) Is it common for complex partial seizures to go along with cortical dysplasia?  3) Is cortical dysplasia rare?  4) What other problems can cortical dysplasia cause, physically and emotionally?  5) Could it be in other parts of the brain which does not show up on the MRI?  6) Where the cortical dysplasia is located, what parts of the body does it effect?  7) Will any of the symptoms get worse?
: I have a ton of questions, but I can't possibly ask them all now.  Please give me some direction as to where I can find more information and whether or not you have had other cases of cortical dysplasia with these type of symptoms.  Thank you for your time.
: Toni Kerce

: : We have extensive experience in dealing with the surgical treatment of cortical dysplasia here in the pediatric neurology section at the Cleveland Clinicas we have one of the largest pediatric epilepsy surgical programs in the country and see this very frequently in association with seizures.
There is a strong association between cortical dysplasia and epilepsy especially complex partial seizures.
If an area of cortex is affected by dysplasia that particular function which is located in this area will be compromised, small areas can be compensated for by adjoining tissue but if the involvement is extensive
any function can be affected.
The disorder is being described more frequently because of high quality MRI scanning and is much more frequent than previously thought.
There is an association with learning difficulties and the extent of dysplasia can be much more extensive than that seen on the MRI sacn , even with the best modern scanners.
The dysplasia which has been seen on the scan could cause in particular perceptual problems, particularly in the area of integration of visual perception, it also can be a focal point for the onset of seizures.
If at any point you wish to have an evaluation at the cleveland Clinic the experts innthis area are DRs Wyllie and Dr Kotagol, the appointments number is (216) 444 5559
:Thank you for responding to inquiry.  I have a couple more questions: Is surgery necessary in the case of cortical dysplasia?   My son has not been diagnosed as having complex partial seizures yet, however, we are told it is extremely hard to diagnose these type of seizures.  The doctor is in the process of arranging for my son to be set up at home with a company called Digitrace to try and track these possible seizures.  Even if it is found that he is not having seizures, should my son be considered to have ADD and what does the paramedian parieto-occipital lobes control? I look forward to hearing from you soon.  Thank you for you help!

Surgery is only necesary if cortical dysplasia is proven to cause seizures
which are not controllable with anti-epileptic medications, so you are a
long way from this stage if it has not even been proven that these are
seizures, much less trying therapy.
Nothing you mention in your posting proves that he has ADHD, this requires hyperactivity
and attention problems ; developmental delay and learning problems alone
are not sufficient to make the diagnosis. If these problems are present he
COULD have the diagnosis with or without the aditional diagnosis
of epilepsy, one really cannot say for sure without having a chance to examine him.
The mesial centro-parietal lobes are mainly concerned with processing
visual information, damage here could cause restriction in the visual

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