Surgical disconnection of epilepsy network correlates with improved outcomes. (March 2020)

• Record Type: Journal Article
• Authors: Neal, Elliot G.; Maciver, Stephanie; Schoenberg, Mike R.; Vale, Fernando L.
• Is Part Of: Seizure. Volume 76(2020)
• Page Start: 56
• Page End: 63
• Publication Date: 2020-03
• Subjects: 18F-FDG PET 18Fluoro-2-deoxyglucose positron emission tomography -- BOLD blood oxygenation level dependent -- BNT Boston Naming Test -- COWAT-FAS Controlled Oral Word Association Test -- ECoG electrocorticography -- EEG electroencephalography -- MNI Montreal Neurological Institute -- rsfMRI resting state functional MRI -- RAVLT6 Rey Auditory Verbal Learning Test, Trial 6 -- RAVLT7 Rey Auditory Verbal Learning Test, Trial 7 -- RFFT Ruff Figural Fluency Test-unique designs -- TLE temporal lobe epilepsy -- FSIQWechsler Adult Intelligence Scale-4th Ed. Full Scale Intelligence Quotient -- LM-IWechsler Memory Scale-4th Ed. Logical Memory Immediate recall subtest -- LM-IIWechsler Memory Scale-4th Ed. Logical Memory Delayed recall subtest -- VR-IWechsler Memory Scale-4th Ed. Visual Reproduction Immediate Recall subtest -- VR-IIWechsler Memory Scale-4th Ed. Visual Reproduction Delayed Recall subtest; Temporal lobe epilepsy -- Resting state connectivity -- Irritative zone -- Epilepsy imaging -- Epilepsy prognosis -- Epilepsy surgery; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2020.01.018
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: A non-invasive automatic software algorithm was developed to map brain connectivity. A higher disconnected network after surgery correlated with seizure control. Network disconnection correlated with relatively improved neuropsychology parameters. Non-invasive modeling network has potential to be useful in pre-operative evaluation. Abstract: Purpose: A novel software algorithm combining non-invasive EEG and resting state functional MRI data to map networks of cortex correlated to epileptogenic tissue was used to map an epilepsy network non-invasively. The relationship between epilepsy network connectivity and outcomes after surgery was investigated using this non-invasive and non-concurrent modeling algorithm. Method: Scalp EEG and resting state functional MRI were acquired for nineteen patients with temporal lobe epilepsy. The hypothetical irritative zone was mapped, and resting state functional MRI data was used to model regions functionally correlated with the irritative zone. Epilepsy network connectivity was measured in patient with temporal lobe epilepsy (n = 19) both pre- and post-operatively. Temporal networks were also mapped in healthy control participants (n = 6). Results: Thirteen of nineteen patients (68 %) were seizure free after 20.3 ± 4.8 months. Epilepsy network connectivity within the temporal lobe was significantly higher among patients with temporal lobe epilepsy compared to the healthy control patients (p < 0.05). Disconnection of the epilepsy network was significantly higher in patients who were seizure free. Using spearman rho analyses, neuropsychological function after surgery was found to be relatively better in patients with higher degree of epilepsy network disconnection. Conclusions: The magnitude of network disconnection after surgery was strongly associated with increased rates of seizure freedom and relatively better neuropsychological measures of memory and naming function. It was shown that seizure-free outcomes and relatively improved neuropsychological function correlated with surgical disconnection of a highly synchronous epilepsy network.