The epileptologist's perspective of focal cortical dysplasia type 3: From concept to management
The recent International League Against Epilepsy (ILAE) official and updated classification of focal cortical dysplasia (FCD) includes a third type-FCD type 3-characterized by architectural abnormalities (cortical dyslamination) associated with another "principal" lesion: hippocampal sclerosis (HS), developmental tumors, vascular malformations, or gliotic scars. We posit that the clinical relevance of FCD type 3 is not established, as dyslamination cannot be reliably identified preoperatively and (although unproven, because unidentifiable) persistence of cortical tissue with putative dyslamination after resective surgery does not preclude seizure control. Here we discuss these issues from the epileptologist's perspective and stimulate the debate on whether the FCD type 3 construct impacts decision-making in the epilepsy surgery field-or else is of little practical significance.
Authors
- Francine Hehn de Oliveira (ORCID: https://orcid.org/0000-0002-1947-0569)
- Thomas Frigeri (ORCID: https://orcid.org/0000-0003-2970-3095)
- André Palmini (ORCID: https://orcid.org/0000-0002-4163-6924)
- Eliseu Paglioli Neto (ORCID: https://orcid.org/0000-0003-3168-5578)
- Harvey B. Sarnat (ORCID: https://orcid.org/0000-0002-6953-2959)
- Ricardo Paganin (ORCID: https://orcid.org/0000-0002-7156-0895)
- Rafael Paglioli (ORCID: https://orcid.org/0009-0003-9888-9214)
- Ricardo Bernardi Soder (ORCID: https://orcid.org/0000-0002-1445-0737)
- William Alves Martins (ORCID: https://orcid.org/0000-0002-8752-5760)
- Vicenzo Zarpellon (ORCID: https://orcid.org/0009-0004-5158-252X)
- Fernanda Schuh (ORCID: https://orcid.org/0009-0004-7644-5011)
Institutions
- Universidade Federal do Rio Grande do Sul (BR)
- Alberta Children's Hospital (CA)
- Instituto do Cérebro (BR)
- Pontifícia Universidade Católica do Rio Grande do Sul (BR)
Publication Details
- Journal
- Epilepsia
- Published
- 2025-11-24
- DOI
- https://doi.org/10.1111/epi.70023
- Primary Topic
- Epilepsy research and treatment
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Cleveland Clinic
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior