Malformations of cortical development in adult patients with epilepsy: A series of 79 cases

Introduction.Malformations of cortical development (MCD) are an important cause of epilepsy, delayed psychomotor development or neurological deficits. Aim. To report on the long-term clinical course and differential characteristics of several groups of MCD in adults with epilepsy.Patients and methods.Our sample consisted of patients over 16 years of age with MCD confirmed by magnetic resonance imaging, and epilepsy. The characteristics of the epilepsy, presence of neurological deficits, intellectual disability, history of perinatal pathology and electroencephalogram recordings were analysed. The patients were classified into three groups (G) in accordance with the Barkovich classification. Results.A total of 85 patients with MCD were identified from 2630 patients with epilepsy and 79 of them were finally included in the sample. Mean age: 37 years, 57% were females. Mean age at onset of the crises: 17.8 years, and 59.5% were medication resistant. The distribution of the cases according to the Barkovich classification was: G1 (alterations affecting neuronal proliferation): 59.5%; G2 (alterations affecting migration): 25.3%; and G3 (alterations affecting cortical organisation): 15.2%. Focal neurological deficit was observed in 19% and 34.2% had an intelligence quotient < 80. On analysing by groups, G3 was found to display a higher percentage of focal neurological and intelligence quotient deficits than G1 and G2 (p < 0.05). Conclusions.Patients with MCD in G3 are more likely to have neurological deficit, intellectual disability and better control over their crises than patients from G1 and G2, most of whom present refractory epilepsy. © 2014 Revista de Neurología.