Focal cortical dysplasia

Focal cortical dysplasia (FCD): Description, Causes and Risk Factors:FCDFocal cortical dysplasia  is a malformation of cortical development, which is the most common cause of medically refractory epilepsy in the Pediatric population and the second/third most common etiology of medically intractable seizures in adults.Focal cortical dysplasia (FCD) is probably the most common form of focal developmental disorder diagnosed in patients with intractable focal epilepsy. The characteristic pathologic abnormalities consist of disruption of cortical lamination with poorly differentiated glial cell elements. Since its original description, focal cortical dysplasia has been recognized to encompass a spectrum of pathologic changes ranging from mild cortical disruption without apparent giant neurons to the most severe forms with cortical dyslamination, large bizarre cells, and astrocytosis. The presence of balloon cells differentiates type I and type II.Both genetic and acquired factors are involved in the pathogenesis of cortical dysplasia. Numerous classifications of the complex structural abnormalities of focal cortical dysplasia have been proposed. Genetic aspects of focal cortical dysplasia are not fully investigated, mainly due to the limited number of cases and lack of proper experimental model. More extensive future studies will certainly shed more light on this problem.Cortical dysplasia is estimated to be present in 1 in 2,500 newborns, making it one of the most common cortical malformations.Symptoms:Epilepsy remains the most common presentation of FCD. Approximately half of patients with epilepsy have some form of FCD; however, some patients with FCDI may not show symptoms or may show only mild cognitive impairment.Diagnosis:After presenting with seizures, a child will often undergo a thorough work-up which includes a neurological examination, imaging studies, such as a CT scan or MRI scan, and an electroencephalogram.Cortical dysplasia can be subtle on MRI and practically invisible on CT. Other imaging studies such as PET scanning sometimes help to find the abnormal location in the brain.Electroencephalograms (EEGs) are performed by placing electrodes on the scalp and recording the electrical activity of the brain. Sometimes this can help localize where the seizures are coming from. If not, occasionally more invasive monitoring studies are performed to confirm the location of seizure origin.Treatment:No specific treatment is required for cortical dysplasia, and all treatment is aimed at the resulting symptoms (typically seizures). When a cortical dysplasia is a cause of epilepsy, then seizure medications (anticonvulsants) are the first-line treatment. If anticonvulsants fail to control seizure activity, Neurosurgery may be an option to remove or disconnect the abnormal cells from the rest of the brain (depending on where the cortical dysplasia is located and the safety of the surgery relative to continued seizures). Neurosurgery can range from removing an entire hemisphere (hemispherectomy), a small lesionectomy, or multiple transections to try and disconnect the abnormal tissue from the rest of the brain (multiple subpial transections). Physical therapy should be considered for infants and children with muscle weakness. Educational therapy is often prescribed for those with developmental delays, but there is no complete treatment for the delays.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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