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Atlas of lesion locations and postsurgical seizure freedom in focal cortical dysplasia: A MELD study.

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cam.issuedOnline2021-11-29
dc.contributor.authorWagstyl, Konrad
dc.contributor.authorWhitaker, Kirstie
dc.contributor.authorRaznahan, Armin
dc.contributor.authorSeidlitz, Jakob
dc.contributor.authorVértes, Petra E
dc.contributor.authorFoldes, Stephen
dc.contributor.authorHumphreys, Zachary
dc.contributor.authorHu, Wenhan
dc.contributor.authorMo, Jiajie
dc.contributor.authorLikeman, Marcus
dc.contributor.authorDavies, Shirin
dc.contributor.authorLenge, Matteo
dc.contributor.authorCohen, Nathan T
dc.contributor.authorTang, Yingying
dc.contributor.authorWang, Shan
dc.contributor.authorRipart, Mathilde
dc.contributor.authorChari, Aswin
dc.contributor.authorTisdall, Martin
dc.contributor.authorBargallo, Nuria
dc.contributor.authorConde-Blanco, Estefanía
dc.contributor.authorPariente, Jose Carlos
dc.contributor.authorPascual-Diaz, Saül
dc.contributor.authorDelgado-Martínez, Ignacio
dc.contributor.authorPérez-Enríquez, Carmen
dc.contributor.authorLagorio, Ilaria
dc.contributor.authorAbela, Eugenio
dc.contributor.authorMullatti, Nandini
dc.contributor.authorO'Muircheartaigh, Jonathan
dc.contributor.authorVecchiato, Katy
dc.contributor.authorLiu, Yawu
dc.contributor.authorCaligiuri, Maria
dc.contributor.authorSinclair, Ben
dc.contributor.authorVivash, Lucy
dc.contributor.authorWillard, Anna
dc.contributor.authorKandasamy, Jothy
dc.contributor.authorMcLellan, Ailsa
dc.contributor.authorSokol, Drahoslav
dc.contributor.authorSemmelroch, Mira
dc.contributor.authorKloster, Ane
dc.contributor.authorOpheim, Giske
dc.contributor.authorYasuda, Clarissa
dc.contributor.authorZhang, Kai
dc.contributor.authorHamandi, Khalid
dc.contributor.authorBarba, Carmen
dc.contributor.authorGuerrini, Renzo
dc.contributor.authorGaillard, William Davis
dc.contributor.authorYou, Xiaozhen
dc.contributor.authorWang, Irene
dc.contributor.authorGonzález-Ortiz, Sofía
dc.contributor.authorSeverino, Mariasavina
dc.contributor.authorStriano, Pasquale
dc.contributor.authorTortora, Domenico
dc.contributor.authorKalviainen, Reetta
dc.contributor.authorGambardella, Antonio
dc.contributor.authorLabate, Angelo
dc.contributor.authorDesmond, Patricia
dc.contributor.authorLui, Elaine
dc.contributor.authorO'Brien, Terry
dc.contributor.authorShetty, Jay
dc.contributor.authorJackson, Graeme
dc.contributor.authorDuncan, John S
dc.contributor.authorWinston, Gavin P
dc.contributor.authorPinborg, Lars
dc.contributor.authorCendes, Fernando
dc.contributor.authorCross, Judith Helen
dc.contributor.authorBaldeweg, Torsten
dc.contributor.authorAdler, Sophie
dc.contributor.orcidWagstyl, Konrad [0000-0003-3439-5808]
dc.contributor.orcidCohen, Nathan T [0000-0002-1410-3487]
dc.contributor.orcidTang, Yingying [0000-0001-5813-0308]
dc.contributor.orcidWang, Shan [0000-0002-6238-2644]
dc.contributor.orcidChari, Aswin [0000-0003-0053-147X]
dc.contributor.orcidConde-Blanco, Estefanía [0000-0001-7436-987X]
dc.contributor.orcidPérez-Enríquez, Carmen [0000-0002-2109-0426]
dc.contributor.orcidOpheim, Giske [0000-0002-1516-0838]
dc.contributor.orcidBarba, Carmen [0000-0001-5445-5842]
dc.contributor.orcidGuerrini, Renzo [0000-0002-7272-7079]
dc.contributor.orcidGaillard, William Davis [0000-0001-5709-0033]
dc.contributor.orcidWang, Irene [0000-0002-3829-5217]
dc.contributor.orcidStriano, Pasquale [0000-0002-6065-1476]
dc.contributor.orcidGambardella, Antonio [0000-0001-7384-3074]
dc.contributor.orcidLabate, Angelo [0000-0002-8827-7324]
dc.contributor.orcidCendes, Fernando [0000-0001-9336-9568]
dc.contributor.orcidBaldeweg, Torsten [0000-0002-5724-1679]
dc.date.accessioned2022-01-10T12:51:05Z
dc.date.available2022-01-10T12:51:05Z
dc.date.issued2022-01
dc.date.submitted2021-08-31
dc.date.updated2022-01-10T12:51:04Z
dc.descriptionFunder: National Institute for Health Research (NIHR) GOSH BRC
dc.description.abstractOBJECTIVE: 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.
dc.identifier.doi10.17863/CAM.80007
dc.identifier.eissn1528-1167
dc.identifier.issn0013-9580
dc.identifier.otherepi17130
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/332557
dc.languageen
dc.language.isoeng
dc.publisherWiley
dc.publisher.urlhttp://dx.doi.org/10.1111/epi.17130
dc.subjectMRI
dc.subjectdrug-resistant epilepsy
dc.subjectfocal cortical dysplasia
dc.subjectlesions
dc.subjectneurosurgery
dc.subjectChild
dc.subjectDrug Resistant Epilepsy
dc.subjectEpilepsy
dc.subjectFreedom
dc.subjectHumans
dc.subjectMagnetic Resonance Imaging
dc.subjectMalformations of Cortical Development
dc.subjectRetrospective Studies
dc.subjectSeizures
dc.subjectTreatment Outcome
dc.titleAtlas of lesion locations and postsurgical seizure freedom in focal cortical dysplasia: A MELD study.
dc.typeArticle
dcterms.dateAccepted2021-11-08
prism.endingPage74
prism.issueIdentifier1
prism.publicationNameEpilepsia
prism.startingPage61
prism.volume63
pubs.funder-project-idMQ: Transforming Mental Health (MQ17-24 Vertes)
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1111/epi.17130

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