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Can cortical dysplasia be present since birth with symptoms occuring later at any age?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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My daughter has the issues listed below. She just came back from her 3rd MRI since XXXXXXX and there are so far no changes to the brain lesion. The doctors are leaning towards it being cortical dysplasia now and not a low grade glioma. My question is, symptoms started a year ago and have gotten worse (memory loss, trouble focusing, tics and seizures). Why would cortical dysplasia show it's symptoms after six years? Isn't this a problem present since birth? Thank you
Posted Mon, 6 Jan 2014 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 3 hours later
Brief Answer: My reply is below. Detailed Answer: Hi, Thank you for posting your query. I have noted the symptoms of your daughter and also the MRI report. I agree that cortical dysplasia is usually present since birth, but the symptoms can occur later at any age, however, most often, symptoms begin in childhood and adolescence. This is because, even though the structural abnormalities of cortical dysplasia are present since birth, the symptoms occur only if electrophysiological abnormalities in conduction of electrical impulses on brain tissue start. This occurs later in life as the brain grows. This abnormality can sometimes be picked up in the EEG. I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, India Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar My BLOG: http://bestneurodoctor.blogspot.in
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Follow-up: Can cortical dysplasia be present since birth with symptoms occuring later at any age? 25 minutes later
Thank you for your response. It seems that the only way they can tell the difference between CD and a tumor is to watch to see if it grows. Are there any other characteristics that would differenciate the two? Thank you
 
 
Answered by Dr. Sudhir Kumar 8 hours later
Brief Answer: Thank you of getting back. Detailed Answer: I would agree with that approach as that is a simple method of finding the difference. The other method is biopsy of the lesion, which is invasive procedure (operation) and is not warranted at present. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: Can cortical dysplasia be present since birth with symptoms occuring later at any age? 4 minutes later
Last question: which is the more favorable diagnosis?it seems to me that they are both very similar. Since they are both lesions on the brain maybe there is not too much difference between them?
 
 
Answered by Dr. Sudhir Kumar 24 minutes later
Brief Answer: Cortical dysplasia is better. Detailed Answer: Thank you for getting back. Cortical dysplasia would be a better diagnosis, as it is a benign condition, and does not lead to major problems. Epilepsy caused by cortical dysplasia can be well controlled with medications in most patients, however, surgery may be required in 20-30% cases. Low grade glioma is a malignancy (cancer), however, it is low grade, and needs surgery. Radiation therapy may also be needed in some cases. Since they are malignant, they can re-grow requiring repeated surgery/radiation. I hope it helps. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: Can cortical dysplasia be present since birth with symptoms occuring later at any age? 32 minutes later
Thank you for your answer. Since a low grade glioma grows slowly what is a safe number of years to watch to make sure its not a glioma? In other words what is the typical rate of growth if any? I also uploaded one of the MRI pictures. She has many strange tics which is why we were first alerted to the fact that something was wrong. The EEG is abnormaL showing cz spikes in awake and asleep modes. But her tics do not show up as anything. I noticed from your hospital website that you have many honors and are an epilepsy specialist as well as movement disorders. Maybe you know more about what these tics are?
 
 
Answered by Dr. Sudhir Kumar 5 hours later
Brief Answer: My reply is below. Detailed Answer: Thank you for getting back and providing more information. I have seen the MRI picture and would agree with your doctor's opinion and plan of management. Definitely, biopsy is not needed, as the lesion is too small. There is no fixed time limit, but if it is glioma, it should grow in 1-2 year period. So, that much follow up could exclude a glioma. Tics (motor) are common in children, however, if it is more severe, along with vocal tics, then, it may need medical treatment. I hope it helps. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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