Atlas of lesion locations and postsurgical seizure freedom in focal cortical dysplasia: A MELD study.
MRI
drug-resistant epilepsy
focal cortical dysplasia
lesions
neurosurgery
Journal
Epilepsia
ISSN: 1528-1167
Titre abrégé: Epilepsia
Pays: United States
ID NLM: 2983306R
Informations de publication
Date de publication:
01 2022
01 2022
Historique:
revised:
07
11
2021
received:
31
08
2021
accepted:
08
11
2021
pubmed:
1
12
2021
medline:
21
4
2022
entrez:
30
11
2021
Statut:
ppublish
Résumé
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. 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. 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%. 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.
Identifiants
pubmed: 34845719
doi: 10.1111/epi.17130
pmc: PMC8916105
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
61-74Subventions
Organisme : Department of Health
Pays : United Kingdom
Organisme : Medical Research Council
ID : G0802012
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 206675/Z/17/Z
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 215901/Z/19/Z
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/M00841X/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/N026063/1
Pays : United Kingdom
Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2021 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.
Références
Neurosurgery. 2018 Jul 1;83(1):93-103
pubmed: 29106684
Brain. 2000 Aug;123 ( Pt 8):1733-51
pubmed: 10908202
Nat Neurosci. 2021 Feb;24(2):176-185
pubmed: 33432195
Lancet Neurol. 2020 Sep;19(9):748-757
pubmed: 32822635
Neuroimage Clin. 2016 Dec 30;14:18-27
pubmed: 28123950
Brain. 2018 Feb 1;141(2):391-408
pubmed: 29365066
N Engl J Med. 2017 Oct 26;377(17):1648-1656
pubmed: 29069555
Neurology. 2014 Jul 1;83(1):48-55
pubmed: 24898923
Proc Natl Acad Sci U S A. 2016 Aug 9;113(32):9105-10
pubmed: 27457931
Seizure. 2006 Sep;15(6):420-7
pubmed: 16787751
Neuroimage. 2018 Sep;178:540-551
pubmed: 29860082
Ann Neurol. 2018 Apr;83(4):676-690
pubmed: 29534299
Epilepsia. 2011 Jan;52(1):158-74
pubmed: 21219302
Neuron. 2021 Sep 15;109(18):2820-2846
pubmed: 34270921
J Magn Reson Imaging. 2008 Apr;27(4):685-91
pubmed: 18302232
Epilepsia. 2022 Jan;63(1):61-74
pubmed: 34845719
PLoS Biol. 2020 Apr 3;18(4):e3000678
pubmed: 32243449
J Neurosurg. 2012 May;116(5):1035-41
pubmed: 22324422
Epilepsia. 2015 Mar;56(3):359-65
pubmed: 25530458
J Neurol Neurosurg Psychiatry. 2008 Jan;79(1):103-5
pubmed: 17682011
Brain. 2018 Apr 1;141(4):1130-1144
pubmed: 29506200
Mol Psychiatry. 2014 Jun;19(6):659-67
pubmed: 23774715
Neurology. 2009 Jan 20;72(3):217-23
pubmed: 19005171
Epilepsy Res. 2018 Jan;139:54-59
pubmed: 29197666
Epilepsy Res. 2014 Nov;108(9):1652-61
pubmed: 25219355
Epilepsy Res. 2010 May;89(2-3):310-8
pubmed: 20227852
N Engl J Med. 2017 Oct 26;377(17):1639-1647
pubmed: 29069568
BMC Med Inform Decis Mak. 2012 Feb 15;12:8
pubmed: 22336388
J Neurosci. 2011 May 11;31(19):7174-7
pubmed: 21562281
Epilepsia. 2018 May;59(5):982-992
pubmed: 29637549
Nat Neurosci. 2015 Dec;18(12):1832-44
pubmed: 26571460
J Neurophysiol. 2011 Sep;106(3):1125-65
pubmed: 21653723
Neuroimage. 2012 Aug 15;62(2):774-81
pubmed: 22248573