Preoperative automated fibre quantification predicts postoperative seizure outcome in temporal lobe epilepsy.
Simon S. Keller,Simon S. Keller,Simon S. Keller,G. Russell Glenn,Bernd Weber,Barbara A. K. Kreilkamp,Barbara A. K. Kreilkamp,Jens H. Jensen,Joseph A. Helpern,Jan Wagner,Jan Wagner,Gareth J. Barker,Mark P. Richardson,Mark P. Richardson,Leonardo Bonilha +14 more
TLDR
Regional tissue characteristics of preoperative temporal lobe white matter tracts known to be important in the generation and propagation of temporal lobe seizures in temporal lobe epilepsy are investigated using diffusion tensor imaging and automated fibre quantification and have the potential to be developed into imaging prognostic markers of postoperative outcome.Abstract:
Approximately one in every two patients with pharmacoresistant temporal lobe epilepsy will not be rendered completely seizure-free after temporal lobe surgery. The reasons for this are unknown and are likely to be multifactorial. Quantitative volumetric magnetic resonance imaging techniques have provided limited insight into the causes of persistent postoperative seizures in patients with temporal lobe epilepsy. The relationship between postoperative outcome and preoperative pathology of white matter tracts, which constitute crucial components of epileptogenic networks, is unknown. We investigated regional tissue characteristics of preoperative temporal lobe white matter tracts known to be important in the generation and propagation of temporal lobe seizures in temporal lobe epilepsy, using diffusion tensor imaging and automated fibre quantification. We studied 43 patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis and 44 healthy controls. Patients underwent preoperative imaging, amygdalohippocampectomy and postoperative assessment using the International League Against Epilepsy seizure outcome scale. From preoperative imaging, the fimbria-fornix, parahippocampal white matter bundle and uncinate fasciculus were reconstructed, and scalar diffusion metrics were calculated along the length of each tract. Altogether, 51.2% of patients were rendered completely seizure-free and 48.8% continued to experience postoperative seizure symptoms. Relative to controls, both patient groups exhibited strong and significant diffusion abnormalities along the length of the uncinate bilaterally, the ipsilateral parahippocampal white matter bundle, and the ipsilateral fimbria-fornix in regions located within the medial temporal lobe. However, only patients with persistent postoperative seizures showed evidence of significant pathology of tract sections located in the ipsilateral dorsal fornix and in the contralateral parahippocampal white matter bundle. Using receiver operating characteristic curves, diffusion characteristics of these regions could classify individual patients according to outcome with 84% sensitivity and 89% specificity. Pathological changes in the dorsal fornix were beyond the margins of resection, and contralateral parahippocampal changes may suggest a bitemporal disorder in some patients. Furthermore, diffusion characteristics of the ipsilateral uncinate could classify patients from controls with a sensitivity of 98%; importantly, by co-registering the preoperative fibre maps to postoperative surgical lacuna maps, we observed that the extent of uncinate resection was significantly greater in patients who were rendered seizure-free, suggesting that a smaller resection of the uncinate may represent insufficient disconnection of an anterior temporal epileptogenic network. These results may have the potential to be developed into imaging prognostic markers of postoperative outcome and provide new insights for why some patients with temporal lobe epilepsy continue to experience postoperative seizures.read more
Citations
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Structural brain abnormalities in the common epilepsies assessed in a worldwide ENIGMA study.
Christopher D. Whelan,Christopher D. Whelan,Andre Altmann,Juan A. Botía,Neda Jahanshad,Derrek P. Hibar,Julie Absil,Saud Alhusaini,Saud Alhusaini,Marina K. M. Alvim,Pia Auvinen,Emanuele Bartolini,Felipe P. G. Bergo,Tauana Bernardes,Karen Blackmon,Karen Blackmon,Barbara Braga,Maria Eugenia Caligiuri,Anna Calvo,Sarah J. A. Carr,Jian Chen,Shuai Chen,Andrea Cherubini,Philippe David,Martin Domin,Sonya Foley,Wendy Franca,Gerrit Haaker,Dmitry Isaev,Simon S. Keller,Raviteja Kotikalapudi,Magdalena A. Kowalczyk,Ruben Kuzniecky,Soenke Langner,Matteo Lenge,Kelly M. Leyden,Min Liu,Richard Q. Loi,Pascal Martin,Mario Mascalchi,Mario Mascalchi,Marcia Elisabete Morita,Jose C. Pariente,Raúl Rodríguez-Cruces,Christian Rummel,Taavi Saavalainen,Mira Semmelroch,Mariasavina Severino,Rhys H. Thomas,Rhys H. Thomas,Manuela Tondelli,Domenico Tortora,Anna Elisabetta Vaudano,Lucy Vivash,Lucy Vivash,Felix von Podewils,Jan Wagner,Jan Wagner,Bernd Weber,Yi Yao,Clarissa L. Yasuda,Guohao Zhang,Núria Bargalló,Benjamin Bender,Neda Bernasconi,Andrea Bernasconi,Boris C. Bernhardt,Ingmar Blümcke,Chad Carlson,Chad Carlson,Gianpiero L. Cavalleri,Fernando Cendes,Luis Concha,Norman Delanty,Norman Delanty,Chantal Depondt,Orrin Devinsky,Colin P. Doherty,Niels K. Focke,Antonio Gambardella,Renzo Guerrini,Khalid Hamandi,Khalid Hamandi,Graeme D. Jackson,Graeme D. Jackson,Reetta Kälviäinen,Peter Kochunov,Patrick Kwan,Angelo Labate,Carrie R. McDonald,Stefano Meletti,Terence J. O'Brien,Terence J. O'Brien,Sebastien Ourselin,Mark P. Richardson,Mark P. Richardson,Pasquale Striano,Thomas Thesen,Thomas Thesen,Roland Wiest,Junsong Zhang,Annamaria Vezzani,Mina Ryten,Mina Ryten,Paul M. Thompson,Sanjay M. Sisodiya +105 more
TL;DR: In the largest neuroimaging study to date, Whelan and colleagues report robust structural alterations across and within epilepsy syndromes, including shared volume loss in the thalamus, and widespread cortical thickness differences.
Journal ArticleDOI
Interictal stereotactic-EEG functional connectivity in refractory focal epilepsies.
Stanislas Lagarde,Nicolas Roehri,Isabelle Lambert,Agnès Trébuchon,Aileen McGonigal,Romain Carron,Didier Scavarda,Mathieu Milh,Francesca Pizzo,Bruno Colombet,Bernard Giusiano,Samuel Medina Villalon,Maxime Guye,Christian Bénar,Fabrice Bartolomei +14 more
TL;DR: This work suggests that, even during the interictal state, functional connectivity is reinforced within epileptic cortices (epileptogenic zone and propagation zone) with a gradual organization, consistent with computational studies suggesting that connectivity is crucial in order to model the spatiotemporal dynamics of seizures.
Journal ArticleDOI
Changing concepts in presurgical assessment for epilepsy surgery
TL;DR: The importance of looking beyond the EEG seizure onset zone and considering focal epilepsy as a brain network disease in which long-range connections need to be taken into account is highlighted, and how new diagnostic techniques are revealing essential information in the brain that was previously hidden from view is explored.
Journal ArticleDOI
Deep learning applied to whole-brain connectome to determine seizure control after epilepsy surgery.
Ezequiel Gleichgerrcht,Brent C. Munsell,Sonal Bhatia,William A. Vandergrift,Chris Rorden,Carrie R. McDonald,Jonathan C. Edwards,Ruben Kuzniecky,Leonardo Bonilha +8 more
TL;DR: This work evaluated whether deep learning applied to whole‐brain presurgical structural connectomes could be used to predict postoperative seizure outcome more accurately than inference from clinical variables in patients with mesial temporal lobe epilepsy (TLE).
Journal ArticleDOI
White matter abnormalities across different epilepsy syndromes in adults: an ENIGMA-Epilepsy study.
Sean N. Hatton,Khoa H Huynh,Leonardo Bonilha,Eugenio Abela,Saud Alhusaini,Saud Alhusaini,Andre Altmann,Marina K. M. Alvim,Akshara R. Balachandra,Akshara R. Balachandra,Emanuele Bartolini,Benjamin Bender,Neda Bernasconi,Andrea Bernasconi,Boris C. Bernhardt,Núria Bargalló,Benoit Caldairou,Maria Eugenia Caligiuri,Sarah J. A. Carr,Gianpiero L. Cavalleri,Gianpiero L. Cavalleri,Fernando Cendes,Luis Concha,Esmaeil Davoodi-Bojd,Patricia Desmond,Orrin Devinsky,Colin P. Doherty,Colin P. Doherty,Martin Domin,John S. Duncan,Niels K. Focke,Sonya Foley,Antonio Gambardella,Ezequiel Gleichgerrcht,Renzo Guerrini,Khalid Hamandi,Khalid Hamandi,Akari Ishikawa,Simon S. Keller,Simon S. Keller,Peter Kochunov,Raviteja Kotikalapudi,Barbara A. K. Kreilkamp,Barbara A. K. Kreilkamp,Patrick Kwan,Patrick Kwan,Angelo Labate,Soenke Langner,Matteo Lenge,Min Liu,Elaine Lui,Elaine Lui,Pascal Martin,Mario Mascalchi,José C. V. Moreira,Marcia Morita-Sherman,Marcia Morita-Sherman,Terence J. O'Brien,Terence J. O'Brien,Heath R. Pardoe,Jose C. Pariente,Letícia F. Ribeiro,Mark P. Richardson,Cristiane S. Rocha,Raúl Rodríguez-Cruces,Raúl Rodríguez-Cruces,Felix Rosenow,Mariasavina Severino,Benjamin Sinclair,Hamid Soltanian-Zadeh,Hamid Soltanian-Zadeh,Pasquale Striano,Pasquale Striano,Peter N Taylor,Rhys H. Thomas,Rhys H. Thomas,Domenico Tortora,Dennis Velakoulis,Dennis Velakoulis,Annamaria Vezzani,Lucy Vivash,Lucy Vivash,Felix von Podewils,Sjoerd B. Vos,Sjoerd B. Vos,Bernd Weber,Gavin P. Winston,Gavin P. Winston,Clarissa L. Yasuda,Alyssa H. Zhu,Paul M. Thompson,Christopher D. Whelan,Christopher D. Whelan,Neda Jahanshad,Sanjay M. Sisodiya,Carrie R. McDonald +95 more
TL;DR: Overall, patients with epilepsy showed white matter abnormalities in the corpus callosum, cingulum and external capsule, with differing severity across epilepsy syndromes, and microstructural abnormalities across major association, commissural, and projection fibres in a large multicentre study of epilepsy are demonstrated.
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