Optimizing Surgical Planning for Epilepsy Patients With Multimodal Neuroimaging and Neurophysiology Integration: A...

Area of Science:

• Neuroscience
• Epileptology
• Medical Imaging

Background:

• Preoperative epilepsy evaluation is complex due to incomplete understanding of network dysfunction.
• Nonlesional frontal lobe epilepsy presents diagnostic challenges for surgical planning.

Observation:

• A patient with nonlesional frontal lobe epilepsy underwent two resective surgeries.
• Four modalities were used: diffusion tensor imaging, resting-state functional MRI, and stereoelectroencephalography (EEG) at rest and during seizures.
• Region-of-interest-based connectivity and betweenness centrality were computed to identify network hubs.

Findings:

• While seizure semiology and EEG suggested right orbitofrontal dysfunction, multimodal analysis revealed key network hubs extending to right temporal areas.
• The right middle temporal lobe was identified as a crucial overlap hub across diffusion tensor imaging, resting-state functional MRI, and rest EEG.
• Resection of this temporal area during the second surgery resulted in long-term seizure control.

Implications:

• Multimodal integration of neuroimaging and neurophysiology can reveal critical epileptogenic network hubs.
• This approach offers a promising strategy to enhance presurgical evaluation for epilepsy.
• Identifying transmodal hubs may improve surgical targeting and patient outcomes in epilepsy surgery.