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

Wagstyl, Konrad, Whitaker, Kirstie, Raznahan, Armin, Seidlitz, Jakob, Vértes, Petra E., Foldes, Stephen, Humphreys, Zachary, Hu, Wenhan, Mo, Jiajie, Likeman, Marcus, Davies, Shirin, Lenge, Matteo, Cohen, Nathan T., Tang, Yingying, Wang, Shan, Ripart, Mathilde, Chari, Aswin, Tisdall, Martin, Bargallo, Nuria, Conde-Blanco, Estefanía, Pariente, Jose Carlos, Pascual-Diaz, Saül, Delgado-Martínez, Ignacio, Pérez-Enríquez, Carmen, Lagorio, Ilaria, Abela, Eugenio, Mullatti, Nandini, O'Muircheartaigh, Jonathan, Vecchiato, Katy, Liu, Yawu, Caligiuri, Maria, Sinclair, Ben, Vivash, Lucy, Willard, Anna, Kandasamy, Jothy, McLellan, Ailsa, Sokol, Drahoslav, Semmelroch, Mira, Kloster, Ane, Opheim, Giske, Yasuda, Clarissa, Zhang, Kai, Hamandi, Khalid, Barba, Carmen, Guerrini, Renzo, Gaillard, William Davis, You, Xiaozhen, Wang, Irene, González?Ortiz, Sofía, Severino, Mariasavina, Striano, Pasquale, Tortora, Domenico, Kalviainen, Reetta, Gambardella, Antonio, Labate, Angelo, Desmond, Patricia, Lui, Elaine, O'Brien, Terry, Shetty, Jay, Jackson, Graeme, Duncan, John S., Winston, Gavin P., Pinborg, Lars, Cendes, Fernando, Cross, Judith Helen, Baldeweg, Torsten and Adler, Sophie 2022. Atlas of lesion locations and postsurgical seizure freedom in focal cortical dysplasia: A MELD study. Epilepsia 63 (1) , pp. 61-74. 10.1111/epi.17130

PDF - Published Version Available under License Creative Commons Attribution. Download (1MB)

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.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Psychology Cardiff University Brain Research Imaging Centre (CUBRIC)
Additional Information:	This is an open access article under the terms of the Creative Commons Attribution License
Publisher:	Wiley
ISSN:	0013-9580
Date of First Compliant Deposit:	8 December 2021
Date of Acceptance:	8 November 2021
Last Modified:	15 May 2023 19:20
URI:	https://orca.cardiff.ac.uk/id/eprint/145971

Citation Data

Cited 20 times in Scopus. View in Scopus. Powered By Scopus® Data

Actions (repository staff only)

Edit Item