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Characterization of postsurgical functional connectivity changes in temporal lobe epilepsy.

Victoria L Morgan1,2,3, Baxter P Rogers1, Hernán F J González2

  • 11Vanderbilt University Institute of Imaging Science, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center.

Journal of Neurosurgery
|June 15, 2019
PubMed
Summary

Mesial temporal lobe epilepsy (mTLE) surgery alters brain functional connectivity, with postsurgical changes predicting seizure recurrence. Understanding these network dynamics can help predict long-term seizure outcomes after mTLE surgery.

Keywords:
MRIconnectivityepilepsy surgeryfunctional neuroimagingfunctional neurosurgerytemporal lobe epilepsy

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Area of Science:

  • Neuroscience
  • Epilepsy Research
  • Medical Imaging

Background:

  • Seizure outcomes after mesial temporal lobe epilepsy (mTLE) surgery vary widely, even in patients with similar presurgical profiles.
  • Hypothesized that brain network connectivity variations contribute to diverse surgical outcomes.
  • Previous studies focused on presurgical connectivity; this study examines presurgical to postsurgical changes.

Purpose of the Study:

  • To characterize functional network connectivity (FC) changes from before to after mTLE surgery.
  • To investigate the relationship between postsurgical connectivity alterations and seizure outcomes.
  • To explore how surgery type and presurgical factors influence network changes.

Main Methods:

  • Studied 20 patients with drug-refractory unilateral mTLE who underwent amygdalohippocampectomy or temporal lobectomy.
  • Measured presurgical and postsurgical FC using 3-T MRI (36.6 ± 14.3 months post-surgery).
  • Compared FC with 44 age-matched healthy controls and correlated changes with clinical data.

Main Results:

  • Significant decreases in FC were observed post-surgery compared to pre-surgery and controls, including contralateral hippocampal connections.
  • Impaired postsurgical contralateral precuneus to ipsilateral occipital connectivity correlated with seizure recurrence.
  • Presurgical connectivity differences were linked to surgical approach (amygdalohippocampectomy vs. temporal lobectomy).
  • Thalamic connectivity changes related to epilepsy duration and seizure frequency.

Conclusions:

  • Widespread contralateral hippocampal FC changes post-surgery may reflect altered epileptogenic progression.
  • Network evolution after surgery can influence long-term seizure outcomes.
  • Combining presurgical network mapping with understanding postsurgical network dynamics may predict seizure recurrence.