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Horsley JJ, Thomas RH, Chowdhury FA, Diehl B, McEvoy AW, Miserocchi A, de Tisi J, Vos SB, Walker MC, Winston GP, Duncan JS, Wang Y, Taylor PN. Complementary structural and functional abnormalities to localise epileptogenic tissue. EBioMedicine 2023; 97:104848. [PMID: 37898096 PMCID: PMC10630610 DOI: 10.1016/j.ebiom.2023.104848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND When investigating suitability for epilepsy surgery, people with drug-refractory focal epilepsy may have intracranial EEG (iEEG) electrodes implanted to localise seizure onset. Diffusion-weighted magnetic resonance imaging (dMRI) may be acquired to identify key white matter tracts for surgical avoidance. Here, we investigate whether structural connectivity abnormalities, inferred from dMRI, may be used in conjunction with functional iEEG abnormalities to aid localisation of the epileptogenic zone (EZ), improving surgical outcomes in epilepsy. METHODS We retrospectively investigated data from 43 patients (42% female) with epilepsy who had surgery following iEEG. Twenty-five patients (58%) were free from disabling seizures (ILAE 1 or 2) at one year. Interictal iEEG functional, and dMRI structural connectivity abnormalities were quantified by comparison to a normative map and healthy controls. We explored whether the resection of maximal abnormalities related to improved surgical outcomes, in both modalities individually and concurrently. Additionally, we suggest how connectivity abnormalities may inform the placement of iEEG electrodes pre-surgically using a patient case study. FINDINGS Seizure freedom was 15 times more likely in patients with resection of maximal connectivity and iEEG abnormalities (p = 0.008). Both modalities separately distinguished patient surgical outcome groups and when used simultaneously, a decision tree correctly separated 36 of 43 (84%) patients. INTERPRETATION Our results suggest that both connectivity and iEEG abnormalities may localise epileptogenic tissue, and that these two modalities may provide complementary information in pre-surgical evaluations. FUNDING This research was funded by UKRI, CDT in Cloud Computing for Big Data, NIH, MRC, Wellcome Trust and Epilepsy Research UK.
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Affiliation(s)
- Jonathan J Horsley
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rhys H Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fahmida A Chowdhury
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Andrew W McEvoy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Anna Miserocchi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Centre for Microscopy, Characterisation, and Analysis, The University of Western Australia, Nedlands, Australia; Centre for Medical Image Computing, Computer Science Department, University College London, London, United Kingdom
| | - Matthew C Walker
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Division of Neurology, Department of Medicine, Queen's University, Kingston, Canada
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Yujiang Wang
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Peter N Taylor
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
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2
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Horsley JJ, Thomas RH, Chowdhury FA, Diehl B, McEvoy AW, Miserocchi A, de Tisi J, Vos SB, Walker MC, Winston GP, Duncan JS, Wang Y, Taylor PN. Complementary structural and functional abnormalities to localise epileptogenic tissue. ARXIV 2023:arXiv:2304.03192v3. [PMID: 37064531 PMCID: PMC10104180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background When investigating suitability for epilepsy surgery, people with drug-refractory focal epilepsy may have intracranial EEG (iEEG) electrodes implanted to localise seizure onset. Diffusion-weighted magnetic resonance imaging (dMRI) may be acquired to identify key white matter tracts for surgical avoidance. Here, we investigate whether structural connectivity abnormalities, inferred from dMRI, may be used in conjunction with functional iEEG abnormalities to aid localisation of the epileptogenic zone (EZ), improving surgical outcomes in epilepsy. Methods We retrospectively investigated data from 43 patients with epilepsy who had surgery following iEEG. Twenty-five patients (58%) were free from disabling seizures (ILAE 1 or 2) at one year. Interictal iEEG functional, and dMRI structural connectivity abnormalities were quantified by comparison to a normative map and healthy controls. We explored whether the resection of maximal abnormalities related to improved surgical outcomes, in both modalities individually and concurrently. Additionally, we suggest how connectivity abnormalities may inform the placement of iEEG electrodes pre-surgically using a patient case study. Findings Seizure freedom was 15 times more likely in patients with resection of maximal connectivity and iEEG abnormalities (p=0.008). Both modalities separately distinguished patient surgical outcome groups and when used simultaneously, a decision tree correctly separated 36 of 43 (84%) patients. Interpretation Our results suggest that both connectivity and iEEG abnormalities may localise epileptogenic tissue, and that these two modalities may provide complementary information in pre-surgical evaluations. Funding This research was funded by UKRI, CDT in Cloud Computing for Big Data, NIH, MRC, Wellcome Trust and Epilepsy Research UK.
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Affiliation(s)
- Jonathan J. Horsley
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rhys H. Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fahmida A. Chowdhury
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Andrew W. McEvoy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Anna Miserocchi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sjoerd B. Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Centre for Microscopy, Characterisation, and Analysis, The University of Western Australia, Nedlands, Australia
- Centre for Medical Image Computing, Computer Science Department, University College London, London, United Kingdom
| | - Matthew C. Walker
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Gavin P. Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Division of Neurology, Department of Medicine, Queen’s University, Kingston, Canada
| | - John S. Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Yujiang Wang
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Peter N. Taylor
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
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3
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Jiang JW, Narasimhan S, Johnson GW, González HFJ, Doss DJ, Shless JS, Paulo DL, Terry DP, Chang C, Morgan VL, Englot DJ. Abnormal functional connectivity of the posterior hypothalamus and other arousal regions in surgical temporal lobe epilepsy. J Neurosurg 2023; 139:640-650. [PMID: 36807210 PMCID: PMC10432570 DOI: 10.3171/2023.1.jns221452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/05/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE This study sought to characterize resting-state functional MRI (fMRI) connectivity patterns of the posterior hypothalamus (pHTH) and the nucleus basalis of Meynert (NBM) in surgical patients with mesial temporal lobe epilepsy (mTLE), and to investigate potential correlations between functional connectivity of these arousal regions and neurocognitive performance. METHODS The study evaluated resting-state fMRI in 60 patients with preoperative mTLE and in 95 healthy controls. The authors first conducted voxel-wise connectivity analyses seeded from the pHTH, combined anterior and tuberal hypothalamus (atHTH; i.e., the rest of the hypothalamus), and the NBM ipsilateral (ipsiNBM) and contralateral (contraNBM) to the epileptogenic zone. Based on these results, the authors included the pHTH, ipsiNBM, and frontoparietal neocortex in a network-based statistic (NBS) analysis to elucidate a network that best distinguishes patients from controls. The connections involving the pHTH and ipsiNBM from this network were included in age-corrected pairwise region of interest (ROI) analysis, along with connections between arousal structures, including the pHTH, ipsiNBM, and brainstem arousal regions. Finally, patient functional connectivity was correlated with clinical neurocognitive testing scores for IQ as well as attention and concentration tests. RESULTS The voxel-wise analysis demonstrated that the pHTH, when compared with the atHTH, showed more widespread functional connectivity decreases in surgical mTLE patients when compared with controls. It was also observed that the ipsiNBM, but not the contraNBM, showed decreased functional connectivity in mTLE. The NBS analysis uncovered a perturbed network of frontoparietal regions, the pHTH, and ipsiNBM that distinguishes patients from controls. Age-corrected ROI analysis revealed functional connectivity decreases between the pHTH and bilateral superior frontal gyri, medial orbitofrontal cortices, rostral anterior cingulate cortices, and inferior parietal cortices in mTLE when compared with controls. For the ipsiNBM, there was reduced connectivity with bilateral medial orbitofrontal and rostral anterior cingulate cortices. Age-corrected ROI analysis also demonstrated upstream connectivity decreases from controls between the pHTH and the brainstem arousal regions, cuneiform/subcuneiform (CSC) nuclei, and ventral tegmental area, as well as the ipsiNBM and CSC nuclei. Reduced functional connectivity was also detected between the pHTH and ipsiNBM. Lastly, neurocognitive test scores for attention and concentration were found to be positively correlated with the functional connectivity between the pHTH and ipsiNBM, suggesting worse performance associated with connectivity perturbations. CONCLUSIONS This study demonstrated perturbed resting-state functional connectivity of arousal regions in surgical mTLE and is one of the first investigations to demonstrate decreased functional connectivity of the pHTH with frontoparietal regions and other arousal regions. Connectivity disturbances in arousal regions may contribute to neurocognitive deficits in surgical mTLE patients.
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Affiliation(s)
- Jasmine W. Jiang
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
| | - Saramati Narasimhan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
| | - Graham W. Johnson
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Hernán F. J. González
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Derek J. Doss
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Jared S. Shless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
| | - Danika L. Paulo
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
| | - Douglas P. Terry
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
| | - Catie Chang
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Victoria L. Morgan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Neurology, Vanderbilt University Medical Center, Nashville
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville
| | - Dario J. Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
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Vilà-Balló A, De la Cruz-Puebla M, López-Barroso D, Miró J, Sala-Padró J, Cucurell D, Falip M, Rodríguez-Fornells A. Reward-based decision-making in mesial temporal lobe epilepsy patients with unilateral hippocampal sclerosis pre- and post-surgery. Neuroimage Clin 2022; 36:103251. [PMID: 36510413 PMCID: PMC9668642 DOI: 10.1016/j.nicl.2022.103251] [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: 04/09/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Correct functioning of the reward processing system is critical for optimizing decision-making as well as preventing the development of addictions and/or neuropsychiatric symptoms such as depression, apathy, and anhedonia. Consequently, patients with mesial temporal lobe epilepsy due to unilateral hippocampal sclerosis (mTLE-UHS) represent an excellent opportunity to study the brain networks involved in this system. OBJECTIVE The aim of the current study was to evaluate decision-making and the electrophysiological correlates of feedback processing in a sample of mTLE-UHS patients, compared to healthy controls. In addition, we assessed the impact of mesial temporal lobe surgical resection on these processes, as well as general, neuropsychological functioning. METHOD 17 mTLE-UHS patients and 17 matched healthy controls completed: [1] a computerized version of the Game of Dice Task, [2] a Standard Iowa Gambling Task, and [3] a modified ERP version of a probabilistic gambling task coupled with multichannel electroencephalography. Neuropsychological scores were also obtained both pre- and post-surgery. RESULTS Behavioral analyses showed a pattern of increased risk for the mTLE-UHS group in decision-making under ambiguity compared to the control group. A decrease in the amplitude of the Feedback Related Negativity (FRN), a weaker effect of valence on delta power, and a general reduction of delta and theta power in the mTLE-UHS group, as compared to the control group, were also found. The beta-gamma activity associated with the delivery of positive reward was similar in both groups. Behavioral performance and electrophysiological measures did not worsen post-surgery. CONCLUSIONS Patients with mTLE-UHS showed impairments in decision-making under ambiguity, particularly when they had to make decisions based on the outcomes of their choices, but not in decision-making under risk. No group differences were observed in decision-making when feedbacks were random. These results might be explained by the abnormal feedback processing seen in the EEG activity of patients with mTLE-UHS, and by concomitant impairments in working memory, and memory. These impairments may be linked to the disruption of mesial temporal lobe networks. Finally, feedback processing and decision-making under ambiguity were already affected in mTLE-UHS patients pre-surgery and did not show evidence of clear worsening post-surgery.
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Affiliation(s)
- Adrià Vilà-Balló
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain,Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain,Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain,Department of Psychology, Faculty of Education and Psychology, University of Girona, Girona, Spain,Corresponding authors.
| | - Myriam De la Cruz-Puebla
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain,Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Department of Cellular Biology, Physiology, and Immunology, Neurosciences Institute, Autonomous University of Barcelona, Barcelona, Spain,Department of Equity in Brain Health, Global Brain Health Institute (GBHI), University of California, San Francisco (UCSF), CA, USA,Department of Internal Medicine, Health Sciences Faculty, Technical University of Ambato, Tungurahua, Ecuador,Dept. of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of Málaga, Málaga, Spain
| | - Diana López-Barroso
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Málaga, Málaga, Spain,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain,Dept. of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of Málaga, Málaga, Spain
| | - Júlia Miró
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain,Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Epilepsy Unit, Neurological Service, Neurology and Genetics Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Jacint Sala-Padró
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain,Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Dept. of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of Málaga, Málaga, Spain
| | - David Cucurell
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain,Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Mercè Falip
- Epilepsy Unit, Neurological Service, Neurology and Genetics Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Antoni Rodríguez-Fornells
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain,Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain,Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain
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Charlebois CM, Anderson DN, Johnson KA, Philip BJ, Davis TS, Newman BJ, Peters AY, Arain AM, Dorval AD, Rolston JD, Butson CR. Patient-specific structural connectivity informs outcomes of responsive neurostimulation for temporal lobe epilepsy. Epilepsia 2022; 63:2037-2055. [PMID: 35560062 PMCID: PMC11265293 DOI: 10.1111/epi.17298] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Responsive neurostimulation is an effective therapy for patients with refractory mesial temporal lobe epilepsy. However, clinical outcomes are variable, few patients become seizure-free, and the optimal stimulation location is currently undefined. The aim of this study was to quantify responsive neurostimulation in the mesial temporal lobe, identify stimulation-dependent networks associated with seizure reduction, and determine if stimulation location or stimulation-dependent networks inform outcomes. METHODS We modeled patient-specific volumes of tissue activated and created probabilistic stimulation maps of local regions of stimulation across a retrospective cohort of 22 patients with mesial temporal lobe epilepsy. We then mapped the network stimulation effects by seeding tractography from the volume of tissue activated with both patient-specific and normative diffusion-weighted imaging. We identified networks associated with seizure reduction across patients using the patient-specific tractography maps and then predicted seizure reduction across the cohort. RESULTS Patient-specific stimulation-dependent connectivity was correlated with responsive neurostimulation effectiveness after cross-validation (p = .03); however, normative connectivity derived from healthy subjects was not (p = .44). Increased connectivity from the volume of tissue activated to the medial prefrontal cortex, cingulate cortex, and precuneus was associated with greater seizure reduction. SIGNIFICANCE Overall, our results suggest that the therapeutic effect of responsive neurostimulation may be mediated by specific networks connected to the volume of tissue activated. In addition, patient-specific tractography was required to identify structural networks correlated with outcomes. It is therefore likely that altered connectivity in patients with epilepsy may be associated with the therapeutic effect and that utilizing patient-specific imaging could be important for future studies. The structural networks identified here may be utilized to target stimulation in the mesial temporal lobe and to improve seizure reduction for patients treated with responsive neurostimulation.
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Affiliation(s)
- Chantel M. Charlebois
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Scientific Computing & Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - Daria Nesterovich Anderson
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
- Department of Pharmacology & Toxicology, University of Utah, Salt Lake City, UT, USA
| | - Kara A. Johnson
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Brian J. Philip
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Tyler. S. Davis
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Blake J. Newman
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Angela Y. Peters
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Amir M. Arain
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Alan D. Dorval
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - John D. Rolston
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Scientific Computing & Imaging Institute, University of Utah, Salt Lake City, UT, USA
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Christopher R. Butson
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
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6
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Horsley JJ, Schroeder GM, Thomas RH, de Tisi J, Vos SB, Winston GP, Duncan JS, Wang Y, Taylor PN. Volumetric and structural connectivity abnormalities co-localise in TLE. Neuroimage Clin 2022; 35:103105. [PMID: 35863179 PMCID: PMC9421455 DOI: 10.1016/j.nicl.2022.103105] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/17/2022] [Accepted: 06/29/2022] [Indexed: 12/02/2022]
Abstract
Patients with temporal lobe epilepsy (TLE) exhibit both volumetric and structural connectivity abnormalities relative to healthy controls. How these abnormalities inter-relate and their mechanisms are unclear. We computed grey matter volumetric changes and white matter structural connectivity abnormalities in 144 patients with unilateral TLE and 96 healthy controls. Regional volumes were calculated using T1-weighted MRI, while structural connectivity was derived using white matter fibre tractography from diffusion-weighted MRI. For each regional volume and each connection strength, we calculated the effect size between patient and control groups in a group-level analysis. We then applied hierarchical regression to investigate the relationship between volumetric and structural connectivity abnormalities in individuals. Additionally, we quantified whether abnormalities co-localised within individual patients by computing Dice similarity scores. In TLE, white matter connectivity abnormalities were greater when joining two grey matter regions with abnormal volumes. Similarly, grey matter volumetric abnormalities were greater when joined by abnormal white matter connections. The extent of volumetric and connectivity abnormalities related to epilepsy duration, but co-localisation did not. Co-localisation was primarily driven by neighbouring abnormalities in the ipsilateral hemisphere. Overall, volumetric and structural connectivity abnormalities were related in TLE. Our results suggest that shared mechanisms may underlie changes in both volume and connectivity alterations in patients with TLE.
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Affiliation(s)
- Jonathan J Horsley
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gabrielle M Schroeder
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rhys H Thomas
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Centre for Microscopy, Characterisation, and Analysis, The University of Western Australia, Nedlands, Australia; Centre for Medical Image Computing, Computer Science Department, University College London, London, United Kingdom
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Division of Neurology, Department of Medicine, Queen's University, Kingston, Canada
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Yujiang Wang
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom; Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Peter N Taylor
- CNNP Lab (www.cnnp-lab.com), Interdisciplinary Computing and Complex BioSystems Group, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom; Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
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7
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Morgan VL, Sainburg LE, Johnson GW, Janson A, Levine KK, Rogers BP, Chang C, Englot DJ. Presurgical temporal lobe epilepsy connectome fingerprint for seizure outcome prediction. Brain Commun 2022; 4:fcac128. [PMID: 35774185 PMCID: PMC9237708 DOI: 10.1093/braincomms/fcac128] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/02/2022] [Accepted: 05/12/2022] [Indexed: 01/19/2023] Open
Abstract
Temporal lobe epilepsy presents a unique situation where confident clinical localization of the seizure focus does not always result in a seizure-free or favourable outcome after mesial temporal surgery. In this work, magnetic resonance imaging derived functional and structural whole-brain connectivity was used to compute a network fingerprint that captures the connectivity profile characteristics that are common across a group of nine of these patients with seizure-free outcome. The connectivity profile was then computed for 38 left-out patients with the hypothesis that similarity to the fingerprint indicates seizure-free surgical outcome. Patient profile distance to the fingerprint was compared with 1-year seizure outcome and standard clinical parameters. Distance to the fingerprint was higher for patients with Engel III-IV 1-year outcome compared with those with Engel Ia, Ib-d, and II outcome (Kruskal-Wallis, P < 0.01; Wilcoxon rank-sum p corr <0.05 Bonferroni-corrected). Receiver operator characteristic analysis revealed 100% sensitivity and 90% specificity in identifying patients with Engel III-IV outcome based on distance to the fingerprint in the left-out patients. Furthermore, distance to the fingerprint was not related to any individual clinical parameter including age at scan, duration of disease, total seizure frequency, presence of mesial temporal sclerosis, lateralizing ictal, interictal scalp electroencephalography, invasive stereo-encephalography, or positron emission tomography. And two published algorithms utilizing multiple clinical measures for predicting seizure outcome were not related to distance to the fingerprint, nor predictive of seizure outcome in this cohort. The functional and structural connectome fingerprint provides quantitative, clinically interpretable and significant information not captured by standard clinical assessments alone or in combinations. This automated and simple method may improve patient-specific prediction of seizure outcome in patients with a clinically identified focus in the mesial temporal lobe.
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Affiliation(s)
- Victoria L Morgan
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, R0102 MCN, Nashville, TN 37232, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Lucas E Sainburg
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, R0102 MCN, Nashville, TN 37232, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Graham W Johnson
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, R0102 MCN, Nashville, TN 37232, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Andrew Janson
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, R0102 MCN, Nashville, TN 37232, USA
| | - Kaela K Levine
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, R0102 MCN, Nashville, TN 37232, USA
| | - Baxter P Rogers
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, R0102 MCN, Nashville, TN 37232, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Catie Chang
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, R0102 MCN, Nashville, TN 37232, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235, USA
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235, USA
| | - Dario J Englot
- Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, R0102 MCN, Nashville, TN 37232, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235, USA
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Johnson GW, Doss DJ, Englot DJ. Network dysfunction in pre and postsurgical epilepsy: connectomics as a tool and not a destination. Curr Opin Neurol 2022; 35:196-201. [PMID: 34799514 PMCID: PMC8891078 DOI: 10.1097/wco.0000000000001008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Patients with focal drug-resistant epilepsy (DRE) sometimes continue to have seizures after surgery. Recently, there is increasing interest in using advanced network analyses (connectomics) to better understand this problem. Connectomics has changed the way researchers and clinicians view DRE, but it must be applied carefully in a hypothesis-driven manner to avoid spurious results. This review will focus on studies published in the last 18 months that have thoughtfully used connectomics to advance our fundamental understanding of network dysfunction in DRE - hopefully for the eventual direct benefit to patient care. RECENT FINDINGS Impactful recent findings have centered on using patient-specific differences in network dysfunction to predict surgical outcome. These works span functional and structural connectivity and include the modalities of functional and diffusion magnetic resonance imaging (MRI) and electrophysiology. Using functional MRI, many groups have described an increased functional segregation outside of the surgical resection zone in patients who fail surgery. Using electrophysiology, groups have reported network characteristics of resected tissue that suggest whether a patient will respond favorably to surgery. SUMMARY If we can develop accurate models to outline functional and structural network characteristics that predict failure of standard surgical approaches, then we can not only improve current clinical decision-making; we can also begin developing alternative treatments including network approaches to improve surgical success rates.
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Affiliation(s)
- Graham W. Johnson
- Department of Biomedical Engineering at Vanderbilt University
- Vanderbilt University Institute of Imaging Science at Vanderbilt University Medical Center
| | - Derek J. Doss
- Department of Biomedical Engineering at Vanderbilt University
- Vanderbilt University Institute of Imaging Science at Vanderbilt University Medical Center
| | - Dario J. Englot
- Department of Biomedical Engineering at Vanderbilt University
- Vanderbilt University Institute of Imaging Science at Vanderbilt University Medical Center
- Department of Neurological Surgery
- Department of Neurology
- Department of Radiology and Radiological Sciences at Vanderbilt University Medical Center
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Abstract
PURPOSE OF REVIEW We review significant advances in epilepsy imaging in recent years. RECENT FINDINGS Structural MRI at 7T with optimization of acquisition and postacquisition image processing increases the diagnostic yield but artefactual findings remain a challenge. MRI analysis from multiple sites indicates different atrophy patterns and white matter diffusion abnormalities in temporal lobe and generalized epilepsies, with greater abnormalities close to the presumed seizure source. Structural and functional connectivity relate to seizure spread and generalization; longitudinal studies are needed to clarify the causal relationship of these associations. Diffusion MRI may help predict surgical outcome and network abnormalities extending beyond the epileptogenic zone. Three-dimensional multimodal imaging can increase the precision of epilepsy surgery, improve seizure outcome and reduce complications. Language and memory fMRI are useful predictors of postoperative deficits, and lead to risk minimization. FDG PET is useful for clinical studies and specific ligands probe the pathophysiology of neurochemical fluxes and receptor abnormalities. SUMMARY Improved structural MRI increases detection of abnormalities that may underlie epilepsy. Diffusion, structural and functional MRI indicate the widespread associations of epilepsy syndromes. These can assist stratification of surgical outcome and minimize risk. PET has continued utility clinically and for research into the pathophysiology of epilepsies.
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Affiliation(s)
- John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London
- MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - Karin Trimmel
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London
- MRI Unit, Chalfont Centre for Epilepsy, Chalfont St Peter, UK
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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