Divergent network properties that predict early surgical failure versus late recurrence in temporal lobe epilepsy

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  • 1 Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center;
  • 2 Departments of Biomedical Engineering and
  • 3 Electrical Engineering and Computer Science, Vanderbilt University; and
  • 4 Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee

OBJECTIVE

The objectives of this study were to identify functional and structural network properties that are associated with early versus long-term seizure outcomes after mesial temporal lobe epilepsy (mTLE) surgery and to determine how these compare to current clinically used methods for seizure outcome prediction.

METHODS

In this case-control study, 26 presurgical mTLE patients and 44 healthy controls were enrolled to undergo 3-T MRI for functional and structural connectivity mapping across an 8-region network of mTLE seizure propagation, including the hippocampus (left and right), insula (left and right), thalamus (left and right), one midline precuneus, and one midline mid-cingulate. Seizure outcome was assessed annually for up to 3 years. Network properties and current outcome prediction methods related to early and long-term seizure outcome were investigated.

RESULTS

A network model was previously identified across 8 patients with seizure-free mTLE. Results confirmed that whole-network propagation connectivity patterns inconsistent with the mTLE model predict early surgical failure. In those patients with networks consistent with the mTLE network, specific bilateral within-network hippocampal to precuneus impairment (rather than unilateral impairment ipsilateral to the seizure focus) was associated with mild seizure recurrence. No currently used clinical variables offered the same ability to predict long-term outcome.

CONCLUSIONS

It is known that there are important clinical differences between early surgical failure that lead to frequent disabling seizures and late recurrence of less frequent mild seizures. This study demonstrated that divergent network connectivity variability, whole-network versus within-network properties, were uniquely associated with these disparate outcomes.

ABBREVIATIONS FC = functional connectivity; fMRI = functional MRI; mTLE = mesial temporal lobe epilepsy; ROC = receiver operating characteristic; SC = structural connectivity.

Contributor Notes

Correspondence Victoria L. Morgan: Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN. victoria.morgan@vanderbilt.edu.

INCLUDE WHEN CITING Published online April 5, 2019; DOI: 10.3171/2019.1.JNS182875.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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