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Wang X, Zhou Y, Deng D, Li H, Guan X, Fang L, Cai Q, Wang W, Zhou Q. Developing a deep learning model to predict epilepsy recurrence in patients with focal cortical dysplasia type III. Quant Imaging Med Surg 2023; 13:999-1008. [PMID: 36819249 PMCID: PMC9929418 DOI: 10.21037/qims-22-276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 12/08/2022] [Indexed: 01/06/2023]
Abstract
Background A sizable number of patients with focal cortical dysplasia (FCD) type III-related refractory epilepsy continue to experience seizures postsurgically. Deep learning models can automatically assess complex medical image characteristics and predict prognosis with higher efficiency. This study sought to determine whether T2-weighted fluid attenuated inversion recovery (T2W FLAIR) images could predict prognosis of FCD type III-related refractory epilepsy using a deep learning approach. Methods Magnetic resonance imaging (MRI) images of 266 patients with FCD type III diagnosed between 2015 and 2019 were included in this retrospective analysis. A deep learning algorithm utilizing a convolutional neural network (CNN) was trained to classify T2W FLAIR images according to Engel's classification. The preprocessed original image and the region of interest (ROI) outlined by clinicians were input into our neural network separately and then together. Precision, sensitivity, specificity, receiver operating characteristic (ROC) curves, and areas under the ROC curves (AUCs) were computed as part of the statistical analyses of the network performance with varied inputs of the network model assessed. Results The overall performance met the following metrics when the original image only was input: AUC of 96.22%, sensitivity of 84.47%, and specificity of 97.21%. The metrics were as follows when the ROI only was input: area under the ROC curve of 94.76%, sensitivity of 84.92%, and specificity of 96.24%. For the combined inputs, the metrics were as follows: AUC of 97.17%, sensitivity of 90.86%, and specificity of 96.63%. Conclusions Deep learning used with conventional MRI can effectively predict the recurrence conditions of epilepsy. Artificial intelligence may help the design of clinical management and enable more precise and individualized prediction for postsurgical prognosis of FCD type III-related refractory epilepsy.
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Affiliation(s)
- Xiaozhuan Wang
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China
| | - Yujia Zhou
- Guangdong Provincial Key Laboratory of Medical Image Processing, Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Dabiao Deng
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China;,Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Honglin Li
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China
| | - Xueqin Guan
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China
| | - Liguang Fang
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China
| | - Qinxin Cai
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China
| | - Wensheng Wang
- Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Quan Zhou
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics, Guangzhou, China
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Thamcharoenvipas T, Takahashi Y, Kimura N, Matsuda K, Usui N. Localizing and Lateralizing Value of Seizure Onset Pattern on Surface EEG in FCD Type II. Pediatr Neurol 2022; 129:48-54. [PMID: 35231790 DOI: 10.1016/j.pediatrneurol.2022.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/26/2021] [Accepted: 01/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surface ictal electroencephalographic (EEG) monitoring has an important role in the presurgical evaluation of patients with focal cortical dysplasia (FCD). This study aimed to examine the characteristics of seizure onset pattern (SOP) on surface ictal EEG. This information will be useful for invasive monitoring planning. METHODS We reviewed 290 seizures from 31 patients with intractable seizures related to FCD type II (6 patients with FCD IIa and 25 patients with FCD IIb). We categorized the SOPs into five patterns and evaluated the relationships between the SOPs and the location and pathology of the FCD II subtype. RESULTS The most common SOP was no apparent change (39.0%), followed by rhythmic slow wave and repetitive spikes/sharp waves. The SOP of rhythmic slow wave was associated with FCD II in the temporal lobe (P < 0.001), and the SOP of no apparent change was associated with FCD II in the occipital lobe (P = 0.012). The SOPs of rhythmic slow waves and fast activity were most common in FCD IIa, P < 0.001 and 0.031, respectively. The repetitive spikes/sharp waves SOP was the most common pattern in FCD IIb (P < 0.001). The surface SOPs provided correct localization and lateralization of epileptic foci in FCD in 62.1% and 62.7%, respectively. In 61.3% of the patients, over 50% of the SOPs in each patient indicated accurate localization. CONCLUSIONS SOPs in surface EEG monitoring are beneficial for presurgical evaluation and lead to localization of epileptic foci and pathologic subtypes of FCD.
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Affiliation(s)
- Titaporn Thamcharoenvipas
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan; Division of Neurology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Yukitoshi Takahashi
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan; Department of Pediatrics, Gifu University School of Medicine, Gifu, Japan; School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan.
| | - Nobusuke Kimura
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Kazumi Matsuda
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Naotaka Usui
- National Epilepsy Center, NHO Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
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Wang X, Deng D, Zhou C, Li H, Guan X, Fang L, Cai Q, Wang W, Zhou Q. Focal Cortical Dysplasia Type Ⅲ Related Medically Refractory Epilepsy: MRI Findings and Potential Predictors of Surgery Outcome. Diagnostics (Basel) 2021; 11:diagnostics11122225. [PMID: 34943462 PMCID: PMC8699898 DOI: 10.3390/diagnostics11122225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
This study aims to explore the relationship between neuropathologic and the post-surgical prognosis of focal cortical dysplasia (FCD) typed-Ⅲ-related medically refractory epilepsy. A total of 266 patients with FCD typed-Ⅲ-related medically refractory epilepsy were retrospectively studied. Presurgical clinical data, type of surgery, and postsurgical seizure outcome were analyzed. The minimum post-surgical follow-up was 1 year. A total of 266 patients of FCD type Ⅲ were included in this study and the median follow-up time was 30 months (range, 12~48 months). Age at onset ranged from 1.0 years to 58.0 years, with a median age of 12.5 years. The number of patients under 12 years old was 133 (50%) in patients with FCD type Ⅲ. A history of febrile seizures was present in 42 (15.8%) cases. In the entire postoperative period, 179 (67.3%) patients were seizure-free. Factors with p < 0.15 in univariate analysis, such as age of onset of epilepsy (p = 0.145), duration of epilepsy (p = 0.004), febrile seizures (p = 0.150), being MRI-negative (p = 0.056), seizure type (p = 0.145) and incomplete resection, were included in multivariate analysis. Multivariate analyses revealed that MRI-negative findings of FCD (OR 0.34, 95% CI 0.45-0.81, p = 0.015) and incomplete resection (OR 0.12, 95% CI 0.05-0.29, p < 0.001) are independent predictors of unfavorable seizure outcomes. MRI-negative finding of FCD lesions and incomplete resection were the most important predictive factors for poor seizure outcome in patients with FCD type Ⅲ.
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Affiliation(s)
- Xiaozhuan Wang
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Dabiao Deng
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
- Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou 510510, China
| | - Chengqian Zhou
- Department of Psychiatry and Behavioral Science, School of Medicine, John Hopkins University, Baltimore, MD 21278, USA;
| | - Honglin Li
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Xueqin Guan
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Liguang Fang
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Qinxin Cai
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
| | - Wensheng Wang
- Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou 510510, China
- Correspondence: (W.W.); (Q.Z.)
| | - Quan Zhou
- Department of Radiology, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; (X.W.); (D.D.); (H.L.); (X.G.); (L.F.); (Q.C.)
- Correspondence: (W.W.); (Q.Z.)
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Babaeeghazvini P, Rueda-Delgado LM, Gooijers J, Swinnen SP, Daffertshofer A. Brain Structural and Functional Connectivity: A Review of Combined Works of Diffusion Magnetic Resonance Imaging and Electro-Encephalography. Front Hum Neurosci 2021; 15:721206. [PMID: 34690718 PMCID: PMC8529047 DOI: 10.3389/fnhum.2021.721206] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
Implications of structural connections within and between brain regions for their functional counterpart are timely points of discussion. White matter microstructural organization and functional activity can be assessed in unison. At first glance, however, the corresponding findings appear variable, both in the healthy brain and in numerous neuro-pathologies. To identify consistent associations between structural and functional connectivity and possible impacts for the clinic, we reviewed the literature of combined recordings of electro-encephalography (EEG) and diffusion-based magnetic resonance imaging (MRI). It appears that the strength of event-related EEG activity increases with increased integrity of structural connectivity, while latency drops. This agrees with a simple mechanistic perspective: the nature of microstructural white matter influences the transfer of activity. The EEG, however, is often assessed for its spectral content. Spectral power shows associations with structural connectivity that can be negative or positive often dependent on the frequencies under study. Functional connectivity shows even more variations, which are difficult to rank. This might be caused by the diversity of paradigms being investigated, from sleep and resting state to cognitive and motor tasks, from healthy participants to patients. More challenging, though, is the potential dependency of findings on the kind of analysis applied. While this does not diminish the principal capacity of EEG and diffusion-based MRI co-registration, it highlights the urgency to standardize especially EEG analysis.
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Affiliation(s)
- Parinaz Babaeeghazvini
- Department of Human Movements Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Science Institute (AMS), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Institute for Brain and Behaviour Amsterdam (iBBA), Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Laura M. Rueda-Delgado
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Jolien Gooijers
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
- KU Leuven Brain Institute (LBI), Leuven, Belgium
| | - Stephan P. Swinnen
- Movement Control & Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
- KU Leuven Brain Institute (LBI), Leuven, Belgium
| | - Andreas Daffertshofer
- Department of Human Movements Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Science Institute (AMS), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Institute for Brain and Behaviour Amsterdam (iBBA), Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Janati AB, ALGhasab NS, Aldaife MY, Khan R, Khan I, Abdullah A, Khan A, Abdelwahed T. Atypical Interictal Epileptiform Discharges in Electroencephalography. J Epilepsy Res 2019; 8:55-60. [PMID: 30809497 PMCID: PMC6374539 DOI: 10.14581/jer.18009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/11/2018] [Accepted: 11/07/2018] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose A great deal of attention has been focused on “typical” interictal epileptiform discharges (IEDs) in the electroencephalography (EEG) literature. However, there is a paucity of data on “atypical” IEDs, namely, positive sharp waves (PSWs), focal triphasic sharp waves and spikes (FTSWs), sharp slow waves (SSWs), bifid spikes, and “notched” delta. In this present study, we sought to address the pathophysiology, characteristics, and diagnostic significance of “atypical” IEDs in clinical neuroscience. Methods We prospectively reviewed the EEGs of 1,250 patients from a heterogeneous population over a period of 2 years. We also documented demographic, clinical, and neuroimaging data. Results Thirty-one patients had PSWs, 26 had FTSWs, 30 had SSWs, 24 had notched delta, and four had bifid spikes in their EEG data. Ninety-six percent of patients with PSWs had epilepsy whereas 100% of the FTSW and SSW groups had this diagnosis. In the ND group the rate of epilepsy was 95% and in the bifid spike group 75%. Accordingly, “atypical” IEDs are potentially epileptogenic patterns with localizing significance, occurring primarily in younger age groups. We also found that a significant number of these patients had congenital central nervous system anomalies. Conclusions We conclude that “atypical” IEDs are rare and under-reported EEG patterns that potentially signify focal epileptogenicity. Our data also stresses the significance of neuroimaging in investigating the possibility of an underlying congenital central nervous system anomaly in this population.
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Affiliation(s)
| | | | | | - Roohi Khan
- King Khalid Hospital (KKH), Hail, Saudi Arabia
| | - Imran Khan
- King Khalid Hospital (KKH), Hail, Saudi Arabia
| | | | - Aslam Khan
- King Khalid Hospital (KKH), Hail, Saudi Arabia
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Abstract
There exists a paucity of data in the EEG literature on characteristics of "atypical" interictal epileptiform discharges (IEDs), including sharp slow waves (SSWs). This article aims to address the clinical, neurophysiological, and neuropathological significance of SSW The EEGs of 920 patients at a tertiary-care facility were prospectively reviewed over a period of one year. Thirty-six patients had SSWs in their EEG. Of these, 6 patients were excluded because of inadequate clinical data. The clinical and neuroimaging data of the remaining 30 patients were then retrospectively collected and reviewed, and the findings were correlated. The data revealed that SSWs were rare and age-related EEG events occurring primarily in the first two decades of life. All patients with SSWs had documented epilepsy, presenting clinically with partial or generalized epilepsy. It is notable that one-third of the patients with SSWs had chronic or static central nervous system (CNS) pathology, particularly congenital CNS anomalies. Though more than one mechanism may be involved in the pathogenesis of SSWs, this research indicates that the most compelling theory is a deeply seated cortical generator giving rise to this EEG pattern. The presence of SSWs should alert clinicians to the presence of partial or generalized epilepsy or an underlying chronic or static CNS pathology, in particular congenital CNS anomalies, underscoring the significance of brain magnetic resonance imaging in the work-up of this population.
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Martin P, Bender B, Focke NK. Post-processing of structural MRI for individualized diagnostics. Quant Imaging Med Surg 2015; 5:188-203. [PMID: 25853079 DOI: 10.3978/j.issn.2223-4292.2015.01.10] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/28/2015] [Indexed: 11/14/2022]
Abstract
Currently, a relevant proportion of all histopathologically proven focal cortical dysplasia (FCD) escape visual detection; this shows the need for additional improvements in analyzing MRI data. A positive MRI is still the strongest prognostic factor for postoperative freedom of seizures. Among several post-processing methods voxel-based morphometry (VBM) of T1- and T2-weighted sequences and T2 relaxometry are routinely applied in pre-surgical diagnostics of cryptogenic epilepsy in epilepsy centers. VBM is superior to conventional visual analysis with 9-15% more identified epileptogenic foci, while T2 relaxometry has its main application in (mesial) temporal lobe epilepsy. Further methods such as surface-based morphometry (SBM) or diffusion tensor imaging are promising but there is a lack of current studies comparing their individual diagnostic value. Post-processing methods represent an important addition to conventional visual analysis but need to be interpreted with expertise and experience so that they should be apprehended as a complementary tool within the context of the multi-modal evaluation of epilepsy patients. This review will give an overview of existing post-processing methods of structural MRI and outline their clinical relevance in detection of epileptogenic structural changes.
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Affiliation(s)
- Pascal Martin
- 1 Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, 2 Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, 72076 Tübingen, Germany
| | - Benjamin Bender
- 1 Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, 2 Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, 72076 Tübingen, Germany
| | - Niels K Focke
- 1 Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, 2 Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, 72076 Tübingen, Germany
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Positive sharp waves in the EEG of children and adults. Neurol Sci 2013; 35:707-13. [PMID: 24281945 DOI: 10.1007/s10072-013-1588-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 11/15/2013] [Indexed: 10/26/2022]
Abstract
Interictal epileptiform discharges (IEDs) with negative polarity have been extensively studied in the EEG literature. However, little attention has been drawn to IED with positive polarity [positive sharp waves (PSWs)]. In this paper, we discuss pathophysiological, neuroimaging, and clinical correlates of this pattern in a heterogeneous group of children and adults who demonstrated PSW in their scalp EEG. We prospectively reviewed the EEGs of 1,250 patients from a heterogeneous population over a period of 1 year. Thirty-one patients had PSW in their EEG. We documented EEG parameters as well as demographic, clinical, and neuroimaging data. Statistical analysis was performed to correlate the aforementioned data. The analysis showed that PSW is an epileptogenic pattern with localizing significance, occurring primarily in the younger age groups. Furthermore, there was a strong association of PSW with chronic and/or static CNS pathology, in particular, congenital CNS anomalies, often accompanied by psychomotor retardation. Patients with "multifocal'' PSW invariably exhibited severe intellectual and motor deficits associated consistently with a variety of congenital CNS insults. PSW is a rare and under-reported EEG abnormality which, similar to negative IED, signifies focal epileptogenecity. The presence of PSW should prompt neuroimaging studies to investigate an associated chronic/static CNS pathology, in particular, congenital CNS anomalies. This association is particularly strong when PSW is multifocal in which case patients present with severe intellectual and motor deficits.
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