Atlas of lesion locations and postsurgical seizure freedom in focal cortical dysplasia: A MELD study
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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.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Epilepsia |
| Vol/bind | 63 |
| Udgave nummer | 1 |
| Sider (fra-til) | 61-74 |
| Antal sider | 14 |
| ISSN | 0013-9580 |
| DOI | |
| Status | Udgivet - 2022 |
Bibliografisk note
Funding Information:
The MELD project is supported by the Rosetrees Trust (A2665). We are grateful to ENIGMA‐Epilepsy for paving the way for collaborative neuroimaging cohorts in epilepsy and open protocols. This work is supported by the National Institute for Health Research (NIHR) Great Ormond Street Hospital (GOSH) Biomedical Research Centre (BRC). The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health. K. Wagstyl is supported by the Wellcome Trust (215901/Z/19/Z). S.A. is supported by the Rosetrees Trust (A2665). X.Y., N.T.C., and W.D.G. are supported by the Hess Foundation. F.C. and C.Y. were supported by the São Paulo Research Foundation (2013/07559‐3; BRAINN‐Brazilian Institute of Neuroscience and Neurotechnology). J.O. is supported by a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (206675/Z/17/Z) and received support from the Medical Research Council Centre for Neurodevelopmental Disorders, King's College London (MR/N026063/1). P.E.V. is a Fellow of MQ: Transforming Mental Health (MQF17_24) and of the Alan Turing Institute funded by EPSRC (EP/N510129/1). J.O. and K.Z. are funded by the National Natural Science Foundation of China (82071457). P.S. acknowledges the Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno‐Infantili (DINOGMI) Department of Excellence of Ministro dell'istruzione, università e ricerca (MIUR) 2018‐2022 (legge 232 del 2016). G.P.W. is supported by the Medical Research Council (G0802012, MR/MR00841X/1). K. Whitaker is supported by the Alan Turing Institute under the Engineering and Physical Sciences Research Council (EPSRC) grant EP/N510129/1. I.W. is supported by the NIH (R01 NS109439).
Funding Information:
The MELD project is supported by the Rosetrees Trust (A2665). We are grateful to ENIGMA-Epilepsy for paving the way for collaborative neuroimaging cohorts in epilepsy and open protocols. This work is supported by the National Institute for Health Research (NIHR) Great Ormond Street Hospital (GOSH) Biomedical Research Centre (BRC). The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health. K. Wagstyl is supported by the Wellcome Trust (215901/Z/19/Z). S.A. is supported by the Rosetrees Trust (A2665). X.Y., N.T.C., and W.D.G. are supported by the Hess Foundation. F.C. and C.Y. were supported by the São Paulo Research Foundation (2013/07559-3; BRAINN-Brazilian Institute of Neuroscience and Neurotechnology). J.O. is supported by a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (206675/Z/17/Z) and received support from the Medical Research Council Centre for Neurodevelopmental Disorders, King's College London (MR/N026063/1). P.E.V. is a Fellow of MQ: Transforming Mental Health (MQF17_24) and of the Alan Turing Institute funded by EPSRC (EP/N510129/1). J.O. and K.Z. are funded by the National Natural Science Foundation of China (82071457). P.S. acknowledges the Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI) Department of Excellence of Ministro dell'istruzione, università e ricerca (MIUR) 2018-2022 (legge 232 del 2016). G.P.W. is supported by the Medical Research Council (G0802012, MR/MR00841X/1). K. Whitaker is supported by the Alan Turing Institute under the Engineering and Physical Sciences Research Council (EPSRC) grant EP/N510129/1. I.W. is supported by the NIH (R01 NS109439).
Publisher Copyright:
© 2021 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy
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