{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T01:19:39Z","timestamp":1789521579007,"version":"build-2803163510"},"reference-count":39,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,7,7]],"date-time":"2023-07-07T00:00:00Z","timestamp":1688688000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["P50 HD105328"],"award-info":[{"award-number":["P50 HD105328"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR001876"],"award-info":[{"award-number":["UL1TR001876"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010621","name":"Pediatric Epilepsy Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010621","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Focal cortical dysplasia (FCD) is the most common etiology of surgically\u2010remediable epilepsy in children. Eighty\u2010seven percent of patients with FCD develop epilepsy (75% is pharmacoresistant epilepsy [PRE]). Focal to bilateral tonic\u2013clonic (FTBTC) seizures are associated with worse surgical outcomes. We hypothesized that children with FCD\u2010related epilepsy with FTBTC seizures are more likely to develop PRE due to lesion interaction with restricted cortical neural networks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients were selected retrospectively from radiology and surgical databases from Children's National Hospital. Inclusion criteria: 3T magnetic resonance imaging (MRI)\u2013confirmed FCD from January 2011 to January 2020; ages 0\u2009days to 22\u2009years at MRI; and 18\u2009months of documented follow\u2010up. FCD dominant network (Yeo 7\u2010network parcellation) was determined. Association of FTBTC seizures with epilepsy severity, surgical outcome, and dominant network was tested. Binomial regression was used to evaluate predictors (FTBTC seizures, age at seizure onset, pathology, hemisphere, lobe) of pharmacoresistance and Engel outcome. Regression was used to evaluate predictors (age at seizure onset, pathology, lobe, percentage default mode network [DMN] overlap) of FTBTC seizures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred seventeen patients had a median age at seizure onset of 3.00\u2009years (interquartile range [IQR] .42\u20135.59\u2009years). Eighty\u2010three patients had PRE (71%); 34 had pharmacosensitive epilepsy (PSE) (29%). Twenty patients (17%) had FTBTC seizures. Seventy\u2010three patients underwent epilepsy surgery. Multivariate regression showed that FTBTC seizures are associated with an increased risk of PRE (odds ratio [OR] 6.41, 95% confidence interval [CI] 1.21\u201333.98,<jats:italic>p<\/jats:italic>\u2009=\u2009.02). FCD hemisphere\/lobe was not associated with PRE. Percentage DMN overlap predicts FTBTC seizures. Seventy\u2010two percent (<jats:italic>n<\/jats:italic>\u2009=\u200952) overall and 53% (<jats:italic>n<\/jats:italic>\u2009=\u20099) of patients with FTBTC seizures achieved Engel class I outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>In a heterogeneous population of surgical and non\u2010operated patients with FCD\u2010related epilepsy, the presence of FTBTC seizures is associated with a tremendous risk of PRE. This finding is a recognizable marker to help neurologists identify those children with FCD\u2010related epilepsy at high risk of PRE and can flag patients for earlier consideration of potentially curative surgery. The FCD\u2010dominant network also contributes to FTBTC seizure clinical expression.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.17700","type":"journal-article","created":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T23:03:20Z","timestamp":1687647800000},"page":"2434-2442","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Focal to bilateral tonic\u2013clonic seizures predict pharmacoresistance in focal cortical dysplasia\u2013related epilepsy"],"prefix":"10.1111","volume":"64","author":[{"given":"Phat","family":"Chang","sequence":"first","affiliation":[{"name":"Center for Neuroscience Research, Children's National Hospital The George Washington University School of Medicine Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Xie","sequence":"additional","affiliation":[{"name":"Center for Neuroscience Research, Children's National Hospital The George Washington University School of Medicine Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkata Sita Priyanka","family":"Illapani","sequence":"additional","affiliation":[{"name":"Center for Neuroscience Research, Children's National Hospital The George Washington University School of Medicine Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaozhen","family":"You","sequence":"additional","affiliation":[{"name":"Center for Neuroscience Research, Children's National Hospital The George Washington University School of Medicine Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tayyba","family":"Anwar","sequence":"additional","affiliation":[{"name":"Center for Neuroscience Research, Children's National Hospital The George Washington University School of Medicine Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archana","family":"Pasupuleti","sequence":"additional","affiliation":[{"name":"Center for Neuroscience Research, Children's National Hospital The George Washington University School of Medicine Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thuy\u2010Anh","family":"Vu","sequence":"additional","affiliation":[{"name":"Center for Neuroscience Research, Children's National Hospital The George Washington University School of Medicine Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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