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Mild forms of focal cortical dysplasia: how certain are we?

The study by Fauser and colleagues on subtypes of focal cortical dysplasia (FCD) and their impact on post-surgical outcome in focal epilepsies (Fauser et al ., 2004) focussed on reports of milder forms of FCD, i.e. focal cortical dysplasia type I (Type 1-FCD) and mild malformations of cortical development (mMCD) according to a recent classification system (Palmini et al ., 2004). These entities were compared with cases with dysmorphic neurons and balloon cells on histopathology (Type 2-FCD).

The histopathological features used for tissue diagnosis and some of the clinical characteristics reported for Type 1-FCD and mMCD deserve comment. The issue of milder forms of FCD—in particular what tissue findings are needed for diagnosis and whether these categories are useful at all—are matters of ongoing debate in epileptology (Palmini and Luders, 2002; Palmini et al ., 2004). For the presumed milder FCD variants, the uncertainties were emphasized and the hope expressed that ‘the use of the proposed classification scheme in every day practice and for research purposes will refine and validate its usefulness’ (Palmini et al ., 2004). The large series presented by Fauser et al . (2004) missed an opportunity to clarify these classifications further since it diverges from the Palmini classification.

It would have been useful for …