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The histopathology-based focal cortical dysplasia (FCD) classification update

The histopathology-based focal cortical dysplasia (FCD) classification update
FCDI* FCDIa abundant microcolumns FCDIb abnormal layering FCDIc vertical and horizontal abnormalities
FCDII* FCDIIa dysmorphic neurons FCDIIb dysmorphic neurons and balloon cells
FCDIII* FCDIIIa cortical dyslamination associated with hippocampal sclerosis FCDIIIb cortical dyslamination adjacent to brain tumor FCDIIIc cortical dyslamination adjacent to vascular malformation FCDIIId cortical dyslamination adjacent to lesion acquired during early life, eg, stroke
White matter* mMCD with excessive heterotopic neurons* mMCD with oligodendroglial hyperplasia in epilepsy (MOGHE)Δ
No definite FCD on histopathology* Abnormality of cortical organization remains ambiguous and histopathologic findings not compatible with FCDI, II or III

* The Task Force (TF) recommends applying immunohistochemical staining for the detection of architectural abnormalities and FCD subtypes, ie, antibodies directed against neuronal nuclear antigen (NeuN), neurofilaments, vimentin, microtubule associated protein 2 (MAP2), CD34, OLIG2, glial fibrillary acid protein (GFAP), or alpha B-crystallin. The diagnostic term of "not otherwise specified (NOS)" shall be used if the microscopic diagnosis is not based on appropriate immunohistochemical staining, eg, FCD type I (NOS).

¶ Mild malformations of cortical development (mMCD): not associated with any other principal lesion, such as hippocampal sclerosis, brain tumor, or vascular malformation.

Δ Although mild malformations of cortical development with oligodendroglial hyperplasia (MOGHE) is primarily a white matter abnormality, abnormal cortical folding can be seen on MRI, and the combination of the two is often interpreted as FCD.

◊ No definite FCD on histopathology: a descriptive report is recommended to highlight anatomic ambiguities in clinically suspected cases of FCD.

From: Najm I, Lal D, Alonso Vanegas M, et al. The ILAE consensus classification of focal cortical dysplasia: An update proposed by an ad hoc task force of the ILAE diagnostic methods commission. Epilepsia 2022; 63:1899. https://onlinelibrary.wiley.com/doi/10.1111/epi.17301. Copyright © 2022 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy. This image has been provided by or is owned by Wiley. Further permission is needed before it can be downloaded to PowerPoint, printed, shared or emailed. Please contact Wiley's permissions department either via email: permissions@wiley.com or use the RightsLink service by clicking on the 'Request Permission' link accompanying this article on Wiley Online Library (https://onlinelibrary.wiley.com/).
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