Mild cortical dysplasia with oligodendroglial hyperplasia (MOGHE) presenting as drug-resistant epilepsy in childhood: a case reportg-Resistant Epilepsy in Childhood: A Case Report
DOI:
https://doi.org/10.59156/g7301r62Keywords:
Drug-resistant epilepsy, Frontal lobe epilepsy, Malformation of cortical development, Oligodendroglial hyperplasia associated with epilepsy (MOGHE)Abstract
Background: epilepsy affects approximately 65 million people worldwide, of whom 20–30% develop drug-resistant epilepsy, defined by the International League Against Epilepsy as the failure to achieve seizure control after the adequate use of at least two appropriately selected and tolerated antiseizure medications. This condition has a significant impact on quality of life and represents a major public health challenge, particularly in the pediatric population, where the identification of rare etiologies is essential.
Objectives: to report an infrequent case of drug-resistant epilepsy in the pediatric population and to optimize diagnostic and therapeutic processes for these conditions.
Case description: 7-year-old female patient with seizure onset at 5 years of age, initially presenting with generalized tonic-clonic seizures and subsequently evolving to focal seizures with secondary generalization. The patient developed drug-resistant epilepsy, experiencing up to three seizures per week despite multiple therapeutic regimens. Video-electroencephalography demonstrated predominant epileptiform activity in the right fronto-centro-temporal regions, while magnetic resonance imaging revealed nonspecific findings consistent with right frontal subcortical gliosis.
Surgery: given the clinical and electrophysiological concordance, surgical treatment was indicated. A right frontal craniotomy with targeted resection of the fronto-opercular region was performed. Histopathological analysis confirmed the diagnosis of mild malformation of cortical development with oligodendroglial hyperplasia associated with epilepsy (MOGHE). The patient had an uncomplicated postoperative course and remained seizure-free without neurological deficits during follow-up.
Conclusion: MOGHE represents a rare and diagnostically challenging etiology of pediatric drug-resistant epilepsy due to its limited expression on neuroimaging studies. The reporting of new cases contributes to improved recognition of this entity and supports the role of surgery as an effective therapeutic option in selected patients.
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