Appearance of FCD Type II Changes with Brain Maturation in Early Childhood

Cases

Two infants with drug-refractory epilepsy ([Table 1]) underwent magnetic resonance imaging (MRI). Case 1 showed subtle lower T2 signal in the right parietal operculum focal cortical dysplasia (FCD) at 12 months which became more apparent at 19 months and 5 years of age ([Fig. 1A]–[C]). In case 2, the right frontal FCD showed pronounced lower T2 signal at 8 weeks, and became less apparent at 5 months of age ([Fig. 1], D-E). Both cases were seizure-free after surgical resection.

Fig. 1 Serial MRI scans in the two reported cases. Case 1: axial T2 MRI at 12-months of age (A) (1.5-Tesla) showed accelerated myelination (T2 hypointensity of the subcortical white matter) adjacent to the right parietal operculum (white arrow), at 19 months of age (B) showed increased T2 signal in the subcortical white matter of the right parietal operculum (white arrow), in keeping with focal cortical dysplasia, and at 5 years of age (C) showed subtle increased T2 signal in subcortical white matter (3-Tesla). Case 2: axial T2 MRI at 8 weeks of age (D) showing low T2 signal in the subcortical white matter of the right frontal lobe (1.5-Tesla) (arrowhead), which partially normalized at 5 months of age (E) (3-Tesla).

Table 1 Clinical characteristics of the two cases

	Case 1	Case 2
Age at seizure onset	4 mo	1 mo
Sex	Female	Male
Seizure types	Staring, bilateral eye flickering, left arm posturing	Behavioral arrest; left arm jerking
Seizure frequency	Multiple times per d	Daily to weekly
Antiepileptic drugs tried	Carbamazepine, lamotrigine, topiramate, clonazepam	Phenobarbital, levetiracetam, Topiramate
Neurodevelopment	Global developmental delay; mild left hand weakness	Mild global developmental delay
MRI brain	The FCD in the right parietal operculum showed subtle lower T2 signal at 12 mo, and became more obvious (high T2 signal) at 19 mo and 5 y of age ([Fig. 1A]–[C]).	The FCD in the right frontal lobe showed obvious lower T2 signal at 8 wk of life, and became less apparent on at 5 mo of age ([Fig. 1] day e).
Scalp EEG–ictal onset	Right hemisphere–parasagittal	Right central
MEG	Cluster of dipoles in the right inferior frontal, inferior rolandic and angular gyrus	Cluster of dipoles in the rolandic and parietal region around the lesion
Age at epilepsy surgery	5 y	5 mo
Form of Invasive EEG monitoring	Subdural grid electrodes and depth electrodes	Intraoperative electrocorticography
Nature of surgery performed	Tailored resection of the lesion	Lesionectomy
Pathology	FCD type IIB	FCD type IIA
Seizure outcome	Seizure free at 12 y of age	Seizure free at 4 y of age

Abbreviations: EEG, Electroencephalography; FCD, focal cortical dysplasia; MEG, magneto-encephalography; MRI, magnetic resonance imaging.

Ethics

Informed consent was obtained from the parents for publication of this report.

• References

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