Structural Brain Network Abnormalities and the Probability of Seizure Recurrence After Epilepsy Surgery
Open Access
- 2 February 2021
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 96 (5), E758-E771
- https://doi.org/10.1212/WNL.0000000000011315
Abstract
Objective We assessed preoperative structural brain networks and clinical characteristics of patients with drugresistant temporal lobe epilepsy (TLE) to identify correlates of postsurgical seizure recurrences. Methods We examined data from 51 patients with TLE who underwent anterior temporal lobe resection (ATLR) and 29 healthy controls. For each patient, using the preoperative structural, diffusion, and postoperative structural MRI, we generated 2 networks: presurgery network and surgically spared network. Standardizing these networks with respect to controls, we determined the number of abnormal nodes before surgery and expected to be spared by surgery. We incorporated these 2 abnormality measures and 13 commonly acquired clinical data from each patient into a robust machine learning framework to estimate patient-specific chances of seizures persisting after surgery. Results Patients with more abnormal nodes had a lower chance of complete seizure freedom at 1 year and, even if seizure-free at 1 year, were more likely to relapse within 5 years. The number of abnormal nodes was greater and their locations more widespread in the surgically spared networks of patients with poor outcome than in patients with good outcome. We achieved an area under the curve of 0.84 +/- 0.06 and specificity of 0.89 +/- 0.09 in predicting unsuccessful seizure outcomes (International League Against Epilepsy [ILAE] 3-5) as opposed to complete seizure freedom (ILAE 1) at 1 year. Moreover, the model-predicted likelihood of seizure relapse was significantly correlated with the grade of surgical outcome at year 1 and associated with relapses up to 5 years after surgery. Conclusion Node abnormality offers a personalized, noninvasive marker that can be combined with clinical data to better estimate the chances of seizure freedom at 1 year and subsequent relapse up to 5 years after ATLR. Classification of Evidence This study provides Class II evidence that node abnormality predicts postsurgical seizure recurrence.This publication has 49 references indexed in Scilit:
- Spatial patterns of water diffusion along white matter tracts in temporal lobe epilepsyNeurology, 2012
- Subtypes of medial temporal lobe epilepsy: Influence on temporal lobectomy outcomes?Epilepsia, 2011
- Referral pattern for epilepsy surgery after evidence-based recommendationsNeurology, 2010
- Temporal lobe epilepsy surgery and the quest for optimal extent of resection: A reviewEpilepsia, 2008
- Early surgical treatment for epilepsyCurrent Opinion in Neurology, 2008
- Voxel‐based morphometry of temporal lobe epilepsy: An introduction and review of the literatureEpilepsia, 2008
- Long-term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosisJournal of Neurosurgery, 2006
- Temporal lobe epilepsy with hippocampal sclerosis: predictors for long-term surgical outcomeBrain, 2004
- Q‐ball imagingMagnetic Resonance in Medicine, 2004
- Proposal for a New Classification of Outcome with Respect to Epileptic Seizures Following Epilepsy SurgeryEpilepsia, 2001