Categorizing cortical dysplasia lesions for surgical outcome using network functional connectivity

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  • 1 Department of Physics, University of Cincinnati, Cincinnati;
  • | 2 Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati;
  • | 3 Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati;
  • | 4 Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati;
  • | 5 Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati; and
  • | 6 Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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OBJECTIVE

Focal cortical dysplasia (FCD) is often associated with drug-resistant epilepsy, leading to a recommendation to surgically remove the seizure focus. Predicting outcome for resection of FCD is challenging, requiring a new approach. Lesion-symptom mapping is a powerful and broadly applicable method for linking neurological symptoms or outcomes to damage to particular brain regions. In this work, the authors applied lesion network mapping, an expansion of the traditional approach, to search for the association of lesion network connectivity with surgical outcomes. They hypothesized that connectivity of lesion volumes, preoperatively identified by MRI, would associate with seizure outcomes after surgery in a pediatric cohort with FCD.

METHODS

This retrospective study included 21 patients spanning the ages of 3 months to 17.7 years with FCD lesions who underwent surgery for drug-resistant epilepsy. The mean brain-wide functional connectivity map of each lesion volume was assessed across a database of resting-state functional MRI data from healthy children (spanning approximately 2.9 to 18.9 years old) compiled at the authors’ institution. Lesion connectivity maps were averaged across age and sex groupings from the database and matched to each patient. The authors sought to associate voxel-wise differences in these maps with subject-specific surgical outcome (seizure free vs persistent seizures).

RESULTS

Lesion volumes with persistent seizures after surgery tended to have stronger connectivity to attention and motor networks and weaker connectivity to the default mode network compared with lesion volumes with seizure-free surgical outcome.

CONCLUSIONS

Network connectivity–based lesion-outcome mapping may offer new insight for determining the impact of lesion volumes discerned according to both size and specific location. The results of this pilot study could be validated with a larger set of data, with the ultimate goal of allowing examination of lesions in patients with FCD and predicting their surgical outcomes.

ABBREVIATIONS

BOLD = blood oxygenation level–dependent; C-MIND = Cincinnati MR Imaging of Neuro-Development; DMN = default mode network; EEG = electroencephalography; FCD = functional cortical dysplasia; ILAE = International League Against Epilepsy; MNI = Montreal Neurological Institute; ROI = region of interest; rsfMRI = resting-state functional MRI.

Supplementary Materials

    • Supplementary Figure 1 (PDF 1,663 KB)

Illustration from Soleman et al. (pp 544–552). Copyright Lucille Solomon.

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