tlas of lesion locations and postsurgical seizure freedom in focal cortical dysplasia: A MELD stud

Author(s):Show less -

Wagstyl, Konrad ^[1] ; Whitaker, Kirstie ^[2] ; Raznahan, Armin ^[3] ; Seidlitz, Jakob ^{[4, 5]} ; Vertes, Petra E. ^[6] ; Foldes, Stephen ^[7] ; Humphreys, Zachary ^[7] ; Hu, Wenhan ^[8] ; Mo, Jiajie ^[8] ; Likeman, Marcus ^[9] ; Davies, Shirin ^{[10, 11]} ; Lenge, Matteo ^[12] ; Cohen, Nathan T. ^[13] ; Tang, Yingying ^{[14, 15]} ; Wang, Shan ^{[15, 16]} ; Ripart, Mathilde ^[17] ; Chari, Aswin ^{[17, 18]} ; Tisdall, Martin ^{[17, 18]} ; Bargallo, Nuria ^{[19, 20]} ; Conde-Blanco, Estefania ^{[19, 20]} ; Carlos Pariente, Jose ^[20] ; Pascual-Diaz, Saul ^[20] ; Delgado-Martinez, Ignacio ^[21] ; Perez-Enriquez, Carmen ^[21] ; Lagorio, Ilaria ^[22] ; Abela, Eugenio ^[23] ; Mullatti, Nandini ^[24] ; O'Muircheartaigh, Jonathan ^[24] ; Vecchiato, Katy ^[24] ; Liu, Yawu ^[25] ; Caligiuri, Maria ^[26] ; Sinclair, Ben ^{[27, 28]} ; Vivash, Lucy ^{[27, 28]} ; Willard, Anna ^{[27, 28]} ; Kandasamy, Jothy ^[29] ; McLellan, Ailsa ^[29] ; Sokol, Drahoslav ^[29] ; Semmelroch, Mira ^[30] ; Kloster, Ane ^{[31, 32]} ; Opheim, Giske ^{[31, 32]} ; Yasuda, Clarissa ^[33] ; Zhang, Kai ^[8] ; Hamandi, Khalid ^{[10, 11]} ; Barba, Carmen ^[12] ; Guerrini, Renzo ^[12] ; Gaillard, William Davis ^[13] ; You, Xiaozhen ^[13] ; Wang, Irene ^[15] ; Gonzalez-Ortiz, Sofia ^[21] ; Severino, Mariasavina ^[22] ; Striano, Pasquale ^[22] ; Tortora, Domenico ^[22] ; Kalviainen, Reetta ^{[25, 34]} ; Gambardella, Antonio ^[26] ; Labate, Angelo ^[26] ; Desmond, Patricia ^[35] ; Lui, Elaine ^[35] ; O'Brien, Terry ^{[27, 28]} ; Shetty, Jay ^[29] ; Jackson, Graeme ^[30] ; Duncan, John S. ^[36] ; Winston, Gavin P. ^{[36, 37]} ; Pinborg, Lars ^{[31, 32]} ; Cendes, Fernando ^[33] ; Cross, Judith Helen ^{[17, 18]} ; Baldeweg, Torsten ^{[17, 18]} ; Adler, Sophie ^{[17, 18]}

Affiliation:Show less -

^[1] Wellcome Ctr Human Neuroimaging, 12 Queen Sq, London WC1N 3AR - England

^[2] Alan Turing Inst, London - England

^[3] NIMH, Dev Neurogen, Bethesda, MD - USA

^[4] Univ Penn, Dept Psychiat, Philadelphia, PA 19104 - USA

^[5] Childrens Hosp Philadelphia, Dept Child & Adolescent Psychiat & Behav Sci, Philadelphia, PA - USA

^[6] Univ Cambridge, Behav & Clin Neurosci Inst, Deparlment Psychiat, Cambridge - England

^[7] Phoenix Childrens Hosp, Barrow Neurol Inst, Phoenix, AZ - USA

^[8] Capital Med Univ, Beijing Tiantan Hosp, Dept Neurosurg, Beijing - Peoples R China

^[9] Bristol Royal Hosp Children, Bristol, Avon - England

^[10] Cardiff Univ, Sch Psychol, Brain Res Imaging Ctr, Cardiff - Wales

^[11] Cardiff & Vale Univ Hlth Board, Univ Hosp Wales, Welsh Epilepsy Unit, Cardiff - Wales

^[12] Meyer Childrens Hosp Univ Florence, Neurosci Dept, Florence - Italy

^[13] Childrens Natl Hosp, Ctr Neurosci, Washington, DC - USA

^[14] Sichuan Univ, Dept Neurol, West China Hosp, Chengdu - Peoples R China

^[15] Cleveland Clin, Neurol Inst, Epilepsy Ctr, Cleveland, OH - USA

^[16] Zhejiang Univ, Affiliated Hosp 2, Epilepsy Ctr, Sch Med, Dept Neurol, Hangzhou - Peoples R China

^[17] UCL, Great Ormond St Inst Child Hlth, London - England

^[18] Natl Hlth Serv Fdn Trust, Great Ormond St Hosp, London - England

^[19] Hosp Clin Barcelona, Barcelona - Spain

^[20] August Pi i Sunyer Biomed Res Inst, Magnet Resonance Core Image Facil, Barcelona - Spain

^[21] Hosp Sea, Barceloneta Promenade, Barcelona - Spain

^[22] Giannina Gaslini Inst, Sci Inst Res & Hlth Care, Genoa - Italy

^[23] Ctr Neuropsychiat & Intellectual Disabil, Aargau Psychiat Serv, Windisch - Switzerland

^[24] Inst Psychiat Psychol & Neurosci, London - England

^[25] Univ Eastern Finland, Dept Neurol, Kuopio - Finland

^[26] Magna Graecia Univ Catanzaro, Inst Neurol, Dept Med & Surg Sci, Catanzaro - Italy

^[27] Monash Univ, Cent Clin Sch, Dept Neurosci, Melbourne, Vic - Australia

^[28] Alfred Hosp, Dept Neurol, Melbourne, Vic - Australia

^[29] Royal Hosp Children & Young People, Edinburgh, Midlothian - Scotland

^[30] Florey Inst Neurosci & Mental Hlth, Heidelberg, Vic - Australia

^[31] Copenhagen Univ Hosp, Dept Neurol, Rigshopsitalet, Neurobiol Res Unit, Copenhagen - Denmark

^[32] Copenhagen Univ Hosp, Dept Neurol, Rigshopsitalet, Epilepsy Clin, Copenhagen - Denmark

^[33] Univ Estadual Campinas, Dept Neurol, Campinas - Brazil

^[34] Kuopio Univ Hosp, Kuopio Epilepsy Ctr, Neuroctr, Kuopio - Finland

^[35] Royal Melbourne Hosp, Dept Radiol, Parkville, Vic - Australia

^[36] UCL, Queen Sq Inst Neurol, London - England

^[37] Queens Univ, Dept Med, Div Neurol, Kingston, ON - Canada

• Document type: Journal article
• Source: Epilepsia; v. 63, n. 1 NOV 2021.
• Web of Science Citations: 2

Abstract

Objective Drug-resistant focal epilepsy is often caused by focal cortical dysplasias (FCDs). The distribution of these lesions across the cerebral cortex and the impact of lesion location on clinical presentation and surgical outcome are largely unknown. We created a neuroimaging cohort of patients with individually mapped FCDs to determine factors associated with lesion location and predictors of postsurgical outcome. Methods The MELD (Multi-centre Epilepsy Lesion Detection) project collated a retrospective cohort of 580 patients with epilepsy attributed to FCD from 20 epilepsy centers worldwide. Magnetic resonance imaging-based maps of individual FCDs with accompanying demographic, clinical, and surgical information were collected. We mapped the distribution of FCDs, examined for associations between clinical factors and lesion location, and developed a predictive model of postsurgical seizure freedom. Results FCDs were nonuniformly distributed, concentrating in the superior frontal sulcus, frontal pole, and temporal pole. Epilepsy onset was typically before the age of 10 years. Earlier epilepsy onset was associated with lesions in primary sensory areas, whereas later epilepsy onset was associated with lesions in association cortices. Lesions in temporal and occipital lobes tended to be larger than frontal lobe lesions. Seizure freedom rates varied with FCD location, from around 30% in visual, motor, and premotor areas to 75% in superior temporal and frontal gyri. The predictive model of postsurgical seizure freedom had a positive predictive value of 70% and negative predictive value of 61%. Significance FCD location is an important determinant of its size, the age at epilepsy onset, and the likelihood of seizure freedom postsurgery. Our atlas of lesion locations can be used to guide the radiological search for subtle lesions in individual patients. Our atlas of regional seizure freedom rates and associated predictive model can be used to estimate individual likelihoods of postsurgical seizure freedom. Data-driven atlases and predictive models are essential for evidence-based, precision medicine and risk counseling in epilepsy. (AU)

• FAPESP's process: 13/07559-3 - BRAINN - The Brazilian Institute of Neuroscience and Neurotechnology
• Grantee: Fernando Cendes
• Support Opportunities: Research Grants - Research, Innovation and Dissemination Centers - RIDC