1. Atlas of lesion locations and postsurgical seizure freedom in focal cortical dysplasia:A MELD study
- Author
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Jose Carlos Pariente, Antonio Gambardella, Fernando Cendes, Ane Kloster, Ailsa McLellan, Ben Sinclair, Terry O'Brien, Jonathan O'Muircheartaigh, Gavin P. Winston, Mira Semmelroch, Estefanía Conde-Blanco, Torsten Baldeweg, Zachary Humphreys, Xiaozhen You, Elaine Lui, Nandini Mullatti, Clarissa L. Yasuda, Domenico Tortora, Stephen T. Foldes, Jakob Seidlitz, Martin Tisdall, Yawu Liu, Carmen Barba, Petra E. Vértes, Angelo Labate, Shan Wang, Konrad Wagstyl, Lars H. Pinborg, Jothy Kandasamy, Irene Wang, Mathilde Ripart, Mariasavina Severino, Aswin Chari, Lucy Vivash, Shirin Davies, Carmen Pérez-Enríquez, Nathan T. Cohen, John S. Duncan, Ilaria Lagorio, Maria Eugenia Caligiuri, Drahoslav Sokol, Reetta Kälviäinen, Eugenio Abela, William D. Gaillard, Giske Opheim, Jiajie Mo, Anna Willard, Graeme D. Jackson, Jay Shetty, JH Cross, Marcus Likeman, Renzo Guerrini, Wenhan Hu, Katy Vecchiato, Khalid Hamandi, Sophie Adler, Kai Zhang, Saül Pascual-Diaz, Matteo Lenge, Ignacio Delgado-Martínez, Kirstie Whitaker, Núria Bargalló, Pasquale Striano, Patricia Desmond, Yingying Tang, Sofía González-Ortiz, Armin Raznahan, Wagstyl, Konrad [0000-0003-3439-5808], Cohen, Nathan T [0000-0002-1410-3487], Tang, Yingying [0000-0001-5813-0308], Wang, Shan [0000-0002-6238-2644], Chari, Aswin [0000-0003-0053-147X], Conde-Blanco, Estefanía [0000-0001-7436-987X], Pérez-Enríquez, Carmen [0000-0002-2109-0426], Opheim, Giske [0000-0002-1516-0838], Barba, Carmen [0000-0001-5445-5842], Guerrini, Renzo [0000-0002-7272-7079], Gaillard, William Davis [0000-0001-5709-0033], Wang, Irene [0000-0002-3829-5217], Striano, Pasquale [0000-0002-6065-1476], Gambardella, Antonio [0000-0001-7384-3074], Labate, Angelo [0000-0002-8827-7324], Cendes, Fernando [0000-0001-9336-9568], Baldeweg, Torsten [0000-0002-5724-1679], and Apollo - University of Cambridge Repository
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Freedom ,medicine.medical_specialty ,Drug Resistant Epilepsy ,lesions ,Lesion ,Epilepsy ,drug-resistant epilepsy ,Neuroimaging ,Seizures ,medicine ,Humans ,neurosurgery ,Child ,Retrospective Studies ,Errata ,business.industry ,Retrospective cohort study ,Cortical dysplasia ,medicine.disease ,Magnetic Resonance Imaging ,Malformations of Cortical Development ,Treatment Outcome ,Neurology ,Frontal lobe ,Neurology (clinical) ,Radiology ,Superior frontal sulcus ,medicine.symptom ,business ,focal cortical dysplasia ,MRI - Abstract
Funder: National Institute for Health Research (NIHR) GOSH BRC, 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.
- Published
- 2022