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Updated: Sep 16, 2025

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Diagnostic performance of morphometric analysis program in pediatric epilepsy surgery.

Valentina Di Micco1, Mattia Mercier1, Camilla Rossi Espagnet2

  • 1Neurology, Epilepsy and Movement Disorders, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Rome, Italy.

Epilepsy & Behavior : E&B
|July 4, 2025
PubMed
Summary

The Morphometric Analysis Program (MAP) aids in evaluating pediatric epilepsy patients for Focal Cortical Dysplasia (FCD). MAP shows good concordance with MRI and electroclinical data in MRI-positive cases, but requires further tools for MRI-negative cases.

Keywords:
Drug-resistant epilepsyEpilepsy surgeryFocal cortical dysplasiaMAPMRI

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Area of Science:

  • Neuroimaging
  • Epilepsy Surgery
  • Pediatric Neurology

Background:

  • Drug-resistant epilepsy in children often necessitates surgical intervention.
  • Accurate localization of epileptogenic zones, such as Focal Cortical Dysplasia (FCD), is crucial for successful surgical outcomes.
  • Noninvasive presurgical evaluation methods are vital for optimizing surgical planning.

Purpose of the Study:

  • To assess the performance of the Morphometric Analysis Program (MAP) in the pre- and post-surgical evaluation of pediatric patients with suspected FCD.
  • To evaluate MAP-electroclinical concordance and the diagnostic contribution of individual MAP features.
  • To optimize noninvasive presurgical assessment for pediatric epilepsy.

Main Methods:

  • MAP analysis was performed on pediatric patients with suspected FCD after Multidisciplinary Surgical Meeting (MSM).
  • Gray/white matter distribution was compared against a non-age-specific database.
  • MAP results were integrated with MRI reevaluation, and concordance was assessed in MRI-positive and MRI-negative cohorts.

Main Results:

  • In the MRI-positive cohort (60%), MAP-MRI concordance reached up to 80% for Junction and nearly 90% for electroclinical concordance for key features.
  • In the MRI-negative cohort (40%), MAP positivity rates varied, with Extension showing 85% positivity, but these rarely aligned with the electroclinical hypothesis.
  • MAP identified two previously undetected dysplastic lesions in the presurgical cohort.

Conclusions:

  • MAP is valuable in identifying FCD lesions, particularly in MRI-positive pediatric epilepsy cases, showing high concordance with MRI and electroclinical data.
  • The 'Junction' feature in MAP appears most reliable for surgical planning in MRI-positive patients.
  • For MRI-negative cases, MAP positivity suggests a need for additional diagnostic tools to enhance lesion detection and surgical strategy.