Categorizing cortical dysplasia lesions for surgical outcome using network functional connectivity

Area of Science:

• Neuroscience
• Epileptology
• Medical Imaging

Background:

• Focal cortical dysplasia (FCD) frequently causes drug-resistant epilepsy, necessitating surgical intervention.
• Predicting surgical outcomes in FCD patients remains a significant clinical challenge.
• Traditional lesion-symptom mapping can be enhanced by considering brain-wide network connectivity.

Purpose of the Study:

• To investigate the association between lesion network connectivity and surgical outcomes in pediatric patients with FCD.
• To apply lesion network mapping, an advanced technique, to predict seizure control after FCD resection.

Main Methods:

• Retrospective analysis of 21 pediatric patients (3 months to 17.7 years) with FCD who underwent epilepsy surgery.
• Assessment of lesion connectivity maps using resting-state functional MRI data from a healthy pediatric cohort.
• Correlation of voxel-wise differences in lesion connectivity maps with surgical outcomes (seizure-free vs. persistent seizures).

Main Results:

• Lesion volumes associated with persistent seizures showed stronger connectivity to attention and motor networks.
• Conversely, lesions linked to seizure freedom exhibited weaker connectivity to the default mode network.
• These findings suggest network connectivity patterns influence surgical success in FCD.

Conclusions:

• Network connectivity-based lesion-outcome mapping offers novel insights into predicting surgical outcomes for FCD.
• This approach can help elucidate the impact of lesion size and location on seizure control.
• Further validation with larger datasets is warranted to refine predictive models for FCD patients.