Abstract
BackgroundSurgery may render temporal lobe epilepsy (TLE) patients seizure-free. However, TLE is a heterogenous entity and surgical prognosis varies between patients. Network-based biomarkers have been shown to be altered in TLE patients and hold promise for classifying TLE subtypes and improving pre-surgical prognosis. The aim of the present study is to investigate a network-based biomarker, the weighted degree of connectivity (wDC), on an individual level, and its relation to TLE subtypes and surgical prognosis.MethodsThirty unilateral TLE patients undergoing the same surgical procedure (anterior temporal resection) and 18 healthy controls were included. All patients were followed-up in the same center for a mean time of 6.85 years and classified as seizure-free (SF) and non seizure-free (non-SF). Using pre-surgical resting state functional MRI, whole brain wDC values for patients and controls were calculated. Then, we divided both temporal lobes in three Regions-of-interest (ROIs) -mesial, pole and lateral- as these areas are known to behave differently in seizure onset and propagation, delimiting different TLE profiles. The wDC values for the defined ROIs of each individual patient were compared with the healthy group.ResultsAfter surgery, 14 TLE patients remained SF. As a group, patients had higher wDC than controls in both the temporal pole (p < 0.05) as well as in the mesial regions (p < 0.002) of the to-be-resected temporal lobe. When comparing between SF and non-SF patients, a step-wise binary logistic regression model including all the ROIs, showed that having an increased wDC of the temporal pole (p < 0.05) and the mesial area (p < 0.05) of the to-be-resected temporal lobe was associated with seizure freedom long-term after surgery.ConclusionsThis study provides a network-based presurgical biomarker that could pave the way towards personalized prediction. In patients with TLE undergoing anterior temporal resections, having an increased wDC at rest could be a signature of the epileptogenic area, and could help identifying those patients who would benefit most from surgery.
Highlights
Surgery may render temporal lobe epilepsy (TLE) patients seizure-free
In order to evaluate the candidacy for surgery in TLE patients, a complete pre-surgical evaluation of patients is performed using multiple investigations [video-electroencephalography (VEEG), neuropsychological studies, structural Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET) and Single Proton Emission Computerized Tomography (SPECT)]
Our aim is to analyze a series of patients with TLE undergoing standard anterior temporal resection (ATLR), including the information from resting-state functional MRI (rs-fMRI) analysis for the characterization of the epileptic network, with the goal of predicting the extension of the disease and detecting which patients will benefit most from surgery, through an individual based approach
Summary
Surgery may render temporal lobe epilepsy (TLE) patients seizure-free. In order to evaluate the candidacy for surgery in TLE patients, a complete pre-surgical evaluation of patients is performed using multiple investigations [video-electroencephalography (VEEG), neuropsychological studies, structural Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET) and Single Proton Emission Computerized Tomography (SPECT)]. This allows assessment for whether the abnormalities observed are regionally confined to the unilateral temporal region, and whether the patient is a good candidate for surgery. Predicting which patients will benefit most from surgery has proven to be difficult, as TLE is a heterogenous disorder, representing different entities [3, 4], and with different patterns of relapse after surgery [5]
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