Atlas of lesion locations and postsurgical seizure freedom in focal cortical dysplasia: A MELD study

Konrad Wagstyl, Wellcome Centre for Human Neuroimaging, London, UK.
Kirstie Whitaker, Alan Turing Institute, London, UK.
Armin Raznahan, Developmental Neurogenomics, National Institute of Mental Health, Bethesda, Maryland, USA.
Jakob Seidlitz, Department of Child and Adolescent Psychiatry and Behavioral Science, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Petra E. Vértes, Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.
Stephen Foldes, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA.Follow
Zachary Humphreys, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA.
Wenhan Hu, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Jiajie Mo, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Marcus Likeman, Bristol Royal Hospital for Children, Bristol, UK.
Shirin Davies, Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff, UK.
Matteo Lenge, Neuroscience Department, Meyer Children's Hospital-University of Florence, Florence, Italy.
Nathan T. Cohen, Center for Neuroscience, Children's National Hospital, Washington, District of Columbia, USA.
Yingying Tang, Department of Neurology, West China Hospital of Sichuan University, Chengdu, China.
Shan Wang, Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Mathilde Ripart, University College London Great Ormond Street Institute for Child Health, London, UK.
Aswin Chari, University College London Great Ormond Street Institute for Child Health, London, UK.
Martin Tisdall, University College London Great Ormond Street Institute for Child Health, London, UK.
Nuria Bargallo, Hospital Clinic of Barcelona, Barcelona, Spain.
Estefanía Conde-Blanco, Hospital Clinic of Barcelona, Barcelona, Spain.
Jose Carlos Pariente, Magnetic Resonance Core Image Facility, August Pi i Sunyer Biomedical Research Institute, Spain.
Saül Pascual-Diaz, Magnetic Resonance Core Image Facility, August Pi i Sunyer Biomedical Research Institute, Spain.
Ignacio Delgado-Martínez, Hospital of the Sea, Barceloneta Promenade, Barcelona, Spain.
Carmen Pérez-Enríquez, Hospital of the Sea, Barceloneta Promenade, Barcelona, Spain.
Ilaria Lagorio, Giannina Gaslini Institute, Scientific Institute for Research and Health Care, Genova, Italy.
Eugenio Abela, Center for Neuropsychiatry and Intellectual Disability, Aargau Psychiatric Services, Windisch, Switzerland.
Nandini Mullatti, Institute of Psychiatry, Psychology, and Neuroscience, London, UK.
Jonathan O'Muircheartaigh, Institute of Psychiatry, Psychology, and Neuroscience, London, UK.
Katy Vecchiato, Institute of Psychiatry, Psychology, and Neuroscience, London, UK.
Yawu Liu, Department of Neurology, University of Eastern Finland, Kuopio, Finland.
Maria Caligiuri, Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.
Ben Sinclair, Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.

Document Type

Article

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.

Keywords

MRI, drug-resistant epilepsy, focal cortical dysplasia, lesions, neurosurgery

Medical Subject Headings

Child; Drug Resistant Epilepsy (complications, diagnostic imaging, surgery); Epilepsy (diagnostic imaging, etiology, surgery); Freedom; Humans; Magnetic Resonance Imaging; Malformations of Cortical Development (complications, diagnostic imaging, surgery); Retrospective Studies; Seizures (diagnostic imaging, etiology, surgery); Treatment Outcome

Publication Date

1-1-2022

Publication Title

Epilepsia

E-ISSN

1528-1167

Volume

63

Issue

1

First Page

61

Last Page

74

PubMed ID

34845719

Digital Object Identifier (DOI)

10.1111/epi.17130

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