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Re: Cortical Dysplasia

Posted By CCF Neuro[P] MD, RPS on April 06, 1999 at 11:06:41:

In Reply to: Cortical Dysplasia posted by Deborah Hale on April 06, 1999 at 10:47:58:

Our daughter is nearly 14 years old. When she was 2, she went into a coma and nearly died.  They were never able to diagnose what caused it, but, either as a result or the cause of the coma, she developed a seizure disorder.   Over the years, her seizures have been mostly controlled with medication.
Upon entering the 7th grade, she began having seizures again -- only more so.  She started having grand mal as well as focal seizures.
Finally, her neurologist ordered an MRI and yesterday he told us she had Cortical dysplasia.
We are meeting with the doc this week and we would like any guidance as to what sort of questions we should ask.  He suggested putting Alice in the hospital on EEG monitoring, which I think is a good idea.  He also said that surgery might be indicated.  But I don't know enough about cortical dysplasia, just what I've read on this site, to even ask intelligent questions.
Any help you might be able to give us would be appreciated.
Thank you.

Dear Ms. Hale:
Sorry to hear about your daughter.  Cortical dysplasia is a condition where the neurons do not migrate to the correct positions in the cortex.  This mismatch can induce cerebral disfunction, such as seizures and learning disabilities.  First, likely the initial seizure event was an expression of the dysgenesis and not the cause of it.  The surgery possibility is a definite possibility, especially if the dysplasia is localized to a specific area and that area is not essential for proper functioning such as language.  How is your daughter developmentally?  Is she in regular classes?  Is there any behavior problems?  Outside of the seizure disorder, are there any concerns?
Some questions you will need to ask your physician.  One, where is the dysplasia located?  is the location near the area where the epileptic zone is located?  If the dysplasia is global, are there areas of more dysplasia than others and if so where are they?  These are all important questions to ask to get a feel for the "amount" of dyplasia.  More precise location of the epileptic zone and symptomatic zone will be needed.  This will be accomplished by video monitoring and EEG.  Then the work-up becomes one of cause and effect.  How much brain can be removed to cause the least amount of long-term sequalae given the extent of the dysplasia.  Will the surgery be beneficial enough in her seizure control to warrant surgery.  Then the next set of questions will be where do you want the surgery to happen, if of course surgery is an option.  I do not want to brag, but we here at the Cleveland Clinic are the world's experts in this area.  No other center does more pediatric surgery for epilepsy.  There of course
other centers that do this type of procedure and I would only recommend centers that do alot of epilepsy surgery.
Best of luck and let us know if we can be of further help.  If surgery is an option, Dr. Elaine Wyllie is the expert in pediatrics to contact here at the Cleveland Clinc, we work together.
CCF Neuro[P] MD

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