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Complementary structural and functional abnormalities to localise epileptogenic tissueResearch in context

Authors :
Jonathan J. Horsley
Rhys H. Thomas
Fahmida A. Chowdhury
Beate Diehl
Andrew W. McEvoy
Anna Miserocchi
Jane de Tisi
Sjoerd B. Vos
Matthew C. Walker
Gavin P. Winston
John S. Duncan
Yujiang Wang
Peter N. Taylor
Source :
EBioMedicine, Vol 97, Iss , Pp 104848- (2023)
Publication Year :
2023
Publisher :
Elsevier, 2023.

Abstract

Summary: Background: When investigating suitability for epilepsy surgery, people with drug-refractory focal epilepsy may have intracranial EEG (iEEG) electrodes implanted to localise seizure onset. Diffusion-weighted magnetic resonance imaging (dMRI) may be acquired to identify key white matter tracts for surgical avoidance. Here, we investigate whether structural connectivity abnormalities, inferred from dMRI, may be used in conjunction with functional iEEG abnormalities to aid localisation of the epileptogenic zone (EZ), improving surgical outcomes in epilepsy. Methods: We retrospectively investigated data from 43 patients (42% female) with epilepsy who had surgery following iEEG. Twenty-five patients (58%) were free from disabling seizures (ILAE 1 or 2) at one year. Interictal iEEG functional, and dMRI structural connectivity abnormalities were quantified by comparison to a normative map and healthy controls. We explored whether the resection of maximal abnormalities related to improved surgical outcomes, in both modalities individually and concurrently. Additionally, we suggest how connectivity abnormalities may inform the placement of iEEG electrodes pre-surgically using a patient case study. Findings: Seizure freedom was 15 times more likely in patients with resection of maximal connectivity and iEEG abnormalities (p = 0.008). Both modalities separately distinguished patient surgical outcome groups and when used simultaneously, a decision tree correctly separated 36 of 43 (84%) patients. Interpretation: Our results suggest that both connectivity and iEEG abnormalities may localise epileptogenic tissue, and that these two modalities may provide complementary information in pre-surgical evaluations. Funding: This research was funded by UKRI, CDT in Cloud Computing for Big Data, NIH, MRC, Wellcome Trust and Epilepsy Research UK.

Details

Language :
English
ISSN :
23523964
Volume :
97
Issue :
104848-
Database :
Directory of Open Access Journals
Journal :
EBioMedicine
Publication Type :
Academic Journal
Accession number :
edsdoj.b91b12e796ba45a78c3f9fa0eb1a9aab
Document Type :
article
Full Text :
https://doi.org/10.1016/j.ebiom.2023.104848