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Suggest Treatment For Focal Cortical Dysplasia

Posted on Wed, 18 Mar 2015

Question: My granddaughter has been diagnosed with focal cortical dysplasia. She is on medication, Keppra, I think, and the seizures seem to be drastically fewer. Most seizures are myoclonic with a few absence seizures, but no tonic, clinic at this point. EEG reveals multifocal spikes, however, and not just generating from the dysplasia. Question: does FCD generally result in deteriorating neurological function? She is very bright and we wonder if cognition will be impacted. Also, could the epilepsy be idiopathic and the dysplasia be a non-contributing factor given the multi-focal nature of spikes on the EEG? Can epilepsy secondary to FCD be controlled with medication, or is it always intractable?

Answered by Dr. Sudhir Kumar (2 hours later)

Brief Answer:
Seizures can be controlled with medications.

Detailed Answer:
Hi,

Thank you for posting your query.

I have noted your grand daughter's clinical details, and reports.

I would like to reassure you that in most (more than 75%) of cases of focal cortical dysplasia (FCD), the seizures get controlled with anti-epileptic drugs (AEDs). So, refractory/intractable seizures in FCD are uncommon.

Yes, it is possible that her seizures are idiopathic and FCD is a contributory factor.

Cognitive and other brain functions remain normal in people with FCD, as FCD is not a progressive condition. FCD is present from birth and does not get worse over time.

However, if seizures do not get controlled, then, cognition may get worse, just as in other people with epilepsy.

I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.

Wishing you good health,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Sudhir Kumar (9 hours later)

Thanks so much for your reply. You have provided some relief from our major concerns. Do you know the probability that her seizures will become tonic clonic? The neurologist is puzzled by the multi-focal spikes, but all of her seizure activity, sometimes a dozen in a day, have been relatively mild myoclonic seizures involving arms and hands or else brief absence seizures. Again, the frequency of the seizures is drastically reduced and she has not yet reached her target dose of medication. How likely is she to progress to tonic clonic seizures?

Answered by Dr. Sudhir Kumar (6 minutes later)

Brief Answer:
Unlikely to progress to tonic-clonic seizures.

Detailed Answer:
Thank you for getting back.

I am pleased to note that her seizure frequency has reduced, and she has not yet reached the target dose of her medication.

The chance of her progressing to tonic-clonic seizures are very less and I do not expect she would progress.

She is likley to have an excellent outcome with Keppra (levetiracetam).

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Shanthi.E