期刊
EPILEPSIA
卷 63, 期 1, 页码 61-74出版社
WILEY
DOI: 10.1111/epi.17130
关键词
drug-resistant epilepsy; focal cortical dysplasia; lesions; MRI; neurosurgery
资金
- Rosetrees Trust [A2665]
- National Institute for Health Research (NIHR) Great Ormond Street Hospital (GOSH) Biomedical Research Centre (BRC)
- Wellcome Trust [215901/Z/19/Z, 206675/Z/17/Z]
- Hess Foundation
- Sao Paulo Research Foundation [2013/07559-3]
- Sir Henry Dale Fellowship - Royal Society [206675/Z/17/Z]
- Medical Research Council Centre for Neurodevelopmental Disorders, King's College London [MR/N026063/1]
- MQ: Transforming Mental Health [MQF17_24]
- EPSRC [EP/N510129/1]
- National Natural Science Foundation of China [82071457]
- Medical Research Council [G0802012, MR/MR00841X/1]
- Alan Turing Institute under the Engineering and Physical Sciences Research Council (EPSRC) [EP/N510129/1]
- NIH [R01 NS109439]
- Sir Henry Dale Fellowship - Wellcome Trust [206675/Z/17/Z]
- Wellcome Trust [206675/Z/17/Z, 215901/Z/19/Z] Funding Source: Wellcome Trust
- Medical Research Council [G0802012, MR/M00841X/1] Funding Source: researchfish
- EPSRC [EP/N510129/1] Funding Source: UKRI
The study revealed that FCDs are unevenly distributed across the cerebral cortex and different lesion locations have significant impact on surgical outcomes. Lesions in the temporal and occipital lobes tend to be larger than frontal lobe lesions, leading to varying rates of seizure freedom post surgery.
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.
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