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.

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