Perilesional white matter integrity in drug-resistant epilepsy related to focal cortical dysplasia
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Published on: September 20, 2024
Bo Jin1, Zhijun Lv2, Wei Chen3
1Department of Neurology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.
Purpose:
We aimed to investigate the differences of white matter (WM) between the focal cortical dysplasia (FCD) patients with drug-resistant epilepsy and those with drug-responsive epilepsy.
Methods:
Thirty epileptic patients with MRI-identified or histologically proven FCD were consecutively enrolled. Fractional anisotropy (FA) and mean diffusivity (MD) of the ipsilateral perilesional WM and contralateral homotopic WM layer masks were computed and corrected by the FA/MD of the corresponding hemispheric WM. The difference was evaluated using paired t-tests. The FA, MD and volumes of hemispheric WM and corpus callosum were also calculated.
Results:
Patients with drug-resistant epilepsy showed significantly decreased FA and increased MD among ipsilateral perilesional WM layer 1 and 2, while patients with drug-responsive epilepsy showed decreased FA in only ipsilateral perilesional WM layer l, compared to remaining ipsilateral perilesional WM layers and contralateral layers 1 through 6. The integrity and volumes of the hemispheric WM and corpus callosum were similar between the two groups.
Conclusion:
We demonstrated that the WM microstructural alterations differed between epileptic patients with FCD according to their antiepileptic drug responses. More extensive perilesional WM abnormality is observed in patients with drug-resistant epilepsy related to FCD.
Insights
White matter (WM) microstructural differences in focal cortical dysplasia (FCD) patients correlate with epilepsy drug response. Drug-resistant epilepsy shows more extensive perilesional WM abnormalities than drug-responsive epilepsy.
Area of Science:
- Neuroimaging
- Epilepsy research
- White matter integrity
Background:
- Focal cortical dysplasia (FCD) is a common cause of drug-resistant epilepsy.
- Understanding white matter (WM) alterations in FCD is crucial for predicting epilepsy outcomes.
Purpose of the Study:
- To investigate differences in white matter (WM) microstructural integrity between drug-resistant and drug-responsive focal cortical dysplasia (FCD) epilepsy patients.
- To compare perilesional and contralateral WM in FCD patients based on their response to antiepileptic drugs.
Main Methods:
- Diffusion tensor imaging (DTI) metrics, including fractional anisotropy (FA) and mean diffusivity (MD), were analyzed in 30 FCD patients.
- WM integrity was assessed in ipsilateral perilesional and contralateral homotopic regions, corrected for hemispheric WM values.
- Paired t-tests were used to evaluate differences in FA and MD between patient groups.
Main Results:
- Drug-resistant epilepsy patients exhibited significantly decreased FA and increased MD in superficial perilesional WM (layers 1 and 2).
- Drug-responsive epilepsy patients showed decreased FA only in the deepest perilesional WM layer (layer 1).
- No significant differences in overall hemispheric WM or corpus callosum integrity/volume were found between groups.
Conclusions:
- White matter microstructural alterations in FCD patients vary based on their response to antiepileptic drugs.
- More extensive perilesional white matter abnormalities are associated with drug-resistant epilepsy in FCD.
- These findings highlight the potential of DTI in characterizing FCD subtypes and predicting treatment outcomes.
