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Association between local gray matter volume differences and stereo-electroencephalography-defined epileptogenicity.

Jacob Bunyamin1, Benjamin Sinclair1,2, Thanomporn Wittayacharoenpong1,2

  • 1Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.

Epilepsia
|October 11, 2025
PubMed
Summary

Gray matter volume (GMV) differences correlate with the epileptogenic zone (EZ) in epilepsy patients. Increased GMV is linked to EZ contacts in MRI-positive cases, while mesiotemporal regions show reduced GMV near EZ contacts.

Keywords:
MRIbiomarkergray matter volumestereo‐EEGvoxel‐based morphometry

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Area of Science:

  • Neuroimaging
  • Epilepsy Research
  • Quantitative MRI

Background:

  • Voxel-based gray matter volume (GMV) quantification has shown moderate success in identifying the epileptogenic zone (EZ).
  • The definition of "ground truth" may influence the accuracy of GMV in EZ identification.
  • Stereo-electroencephalography (SEEG) provides detailed electrophysiological data for localizing seizure onset.

Purpose of the Study:

  • To investigate the association between GMV differences and SEEG-defined epileptogenicity.
  • To explore GMV as a potential imaging biomarker for the EZ.
  • To evaluate the utility of GMV in differentiating EZ from other brain regions in epilepsy patients.

Main Methods:

  • Included 50 SEEG patients and 51 controls, performing voxel-based permutation inference on T1-weighted MRI scans.
  • Classified SEEG contacts based on EZ definition (radiofrequency thermocoagulation) and active irritative zones (top 10% HFOs).
  • Utilized mixed-effects logistic regressions and performance analysis to assess GMV associations with EZ and irritative zones.

Main Results:

  • Increased GMV correlated with EZ contacts in the overall cohort (OR 1.21) and MRI-positive group (OR 1.45), but not MRI-negative.
  • Reduced GMV was associated with EZ contacts in mesiotemporal regions (OR 0.53), while increased GMV was found in neocortical areas (OR 1.32).
  • Within MRI-visible lesions, increased GMV positively associated with EZ contacts (OR 1.50). Increased GMV linked to neocortical irritative zone contacts in MRI-positive cases.

Conclusions:

  • Local GMV differences are associated with EZ contacts in the whole cohort and MRI-positive patients.
  • Associations varied by region, with positive links in the neocortex and negative in mesiotemporal structures.
  • Increased GMV within MRI-visible lesions is a significant finding associated with EZ contacts.