Journal
ANNALS OF NEUROLOGY
Volume 77, Issue 6, Pages 1060-1075Publisher
WILEY
DOI: 10.1002/ana.24407
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Funding
- Epilepsy Foundation Postdoctoral Fellowship Grant
- NIH National Institute of Neurological Disorders and Stroke [R01-NS074980]
- Lester and Edward Anixter Family Foundation
- JoshProvides Epilepsy Assistance Foundation
- UCB
- Pfizer
- American Epilepsy Society
- Citizens United for Research in Epilepsy
- US Department of Defense
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ObjectiveIn the presurgical workup of magnetic resonance imaging (MRI)-negative (MRI- or nonlesional) pharmacoresistant focal epilepsy (PFE) patients, discovering a previously undetected lesion can drastically change the evaluation and likely improve surgical outcome. Our study utilizes a voxel-based MRI postprocessing technique, implemented in a morphometric analysis program (MAP), to facilitate detection of subtle abnormalities in a consecutive cohort of MRI- surgical candidates. MethodsIncluded in this retrospective study was a consecutive cohort of 150 MRI- surgical patients. MAP was performed on T1-weighted MRI, with comparison to a scanner-specific normal database. Review and analysis of MAP were performed blinded to patients' clinical information. The pertinence of MAP(+) areas was confirmed by surgical outcome and pathology. ResultsMAP showed a 43% positive rate, sensitivity of 0.9, and specificity of 0.67. Overall, patients with the MAP(+) region completely resected had the best seizure outcomes, followed by the MAP(-) patients, and patients who had no/partial resection of the MAP(+) region had the worst outcome (p<0.001). Subgroup analysis revealed that visually identified subtle findings are more likely correct if also MAP(+). False-positive rate in 52 normal controls was 2%. Surgical pathology of the resected MAP(+) areas contained mainly non-balloon-cell focal cortical dysplasia (FCD). Multiple MAP(+) regions were present in 7% of patients. InterpretationMAP can be a practical and valuable tool to: (1) guide the search for subtle MRI abnormalities and (2) confirm visually identified questionable abnormalities in patients with PFE due to suspected FCD. A MAP(+) region, when concordant with the patient's electroclinical presentation, should provide a legitimate target for surgical exploration. Ann Neurol 2015;77:1060-1075
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