OBJECTIVE: MRI-negative (MRI-) pharmacoresistant focal epilepsy (PFE) patients are most challenging for epilepsy surgical management. This study utilizes a voxel-based MRI postprocessing technique, implemented using a morphometric analysis program (MAP), aiming to facilitate detection of subtle focal cortical dysplasia (FCD) in MRI- patients. Furthermore, the study examines the concordance between MAP-identified regions and localization from magnetic source imaging (MSI). METHODS: Included in this retrospective study were 25 MRI- surgical patients. MAP was performed on T1-weighted MRI, with comparison to a normal database. The pertinence of MAP+ areas was confirmed by MSI, surgical outcome and pathology. Analyses of MAP and MSI were performed blindly from patients' clinical information and independently from each other. RESULTS: The detection rate of subtle changes by MAP was 48% (12/25). Once MAP+ areas were resected, patients were more likely to be seizure-free (p=0.02). There were no false positives in the 25 age-matched normal controls. Seven patients had a concordant MSI correlate. Patients in whom a concordant area was identified by both MAP and MSI had a significantly higher chance of achieving a seizure-free outcome following complete resection of this area (p=0.008). In the 9 resected MAP+ areas, pathology revealed FCD type IA in 7 and type IIB in 2. INTERPRETATION: MAP shows promise in identifying subtle FCD abnormalities and increasing the diagnostic yield of conventional MRI visual analysis in presurgical evaluation of PFE. Concordant MRI postprocessing and MSI analyses may lead to the noninvasive identification of a structurally and electrically abnormal subtle lesion that can be surgically targeted.
OBJECTIVE: MRI-negative (MRI-) pharmacoresistant focal epilepsy (PFE) patients are most challenging for epilepsy surgical management. This study utilizes a voxel-based MRI postprocessing technique, implemented using a morphometric analysis program (MAP), aiming to facilitate detection of subtle focal cortical dysplasia (FCD) in MRI- patients. Furthermore, the study examines the concordance between MAP-identified regions and localization from magnetic source imaging (MSI). METHODS: Included in this retrospective study were 25 MRI- surgical patients. MAP was performed on T1-weighted MRI, with comparison to a normal database. The pertinence of MAP+ areas was confirmed by MSI, surgical outcome and pathology. Analyses of MAP and MSI were performed blindly from patients' clinical information and independently from each other. RESULTS: The detection rate of subtle changes by MAP was 48% (12/25). Once MAP+ areas were resected, patients were more likely to be seizure-free (p=0.02). There were no false positives in the 25 age-matched normal controls. Seven patients had a concordant MSI correlate. Patients in whom a concordant area was identified by both MAP and MSI had a significantly higher chance of achieving a seizure-free outcome following complete resection of this area (p=0.008). In the 9 resected MAP+ areas, pathology revealed FCD type IA in 7 and type IIB in 2. INTERPRETATION: MAP shows promise in identifying subtle FCD abnormalities and increasing the diagnostic yield of conventional MRI visual analysis in presurgical evaluation of PFE. Concordant MRI postprocessing and MSI analyses may lead to the noninvasive identification of a structurally and electrically abnormal subtle lesion that can be surgically targeted.
Authors: Hans-Jürgen Huppertz; Christina Grimm; Susanne Fauser; Jan Kassubek; Irina Mader; Albrecht Hochmuth; Joachim Spreer; Andreas Schulze-Bonhage Journal: Epilepsy Res Date: 2005-09-19 Impact factor: 3.045
Authors: M T Doelken; A Mennecke; H J Huppertz; S Rampp; E Lukacs; B S Kasper; T Kuwert; P Ritt; A Doerfler; H Stefan; T Hammen Journal: J Neuroradiol Date: 2011-07-01 Impact factor: 3.447
Authors: Pavel Krsek; Martin Kudr; Alena Jahodova; Vladimir Komarek; Bruno Maton; Stephen Malone; Ian Miller; Prasanna Jayakar; Trevor Resnick; Michael Duchowny Journal: Epilepsia Date: 2013-01-07 Impact factor: 5.864
Authors: Robert C Knowlton; Rotem A Elgavish; Nita Limdi; Al Bartolucci; Buddhiwardhan Ojha; Jeffrey Blount; Jorge G Burneo; Lawrence Ver Hoef; Lebron Paige; Edward Faught; Pongkiat Kankirawatana; Kristen Riley; Ruben Kuzniecky Journal: Ann Neurol Date: 2008-07 Impact factor: 10.422
Authors: Z Irene Wang; Andreas V Alexopoulos; Stephen E Jones; Zeenat Jaisani; Imad M Najm; Richard A Prayson Journal: Mod Pathol Date: 2013-04-05 Impact factor: 7.842
Authors: Hiroatsu Murakami; Zhong I Wang; Ahmad Marashly; Balu Krishnan; Richard A Prayson; Yosuke Kakisaka; John C Mosher; Juan Bulacio; Jorge A Gonzalez-Martinez; William E Bingaman; Imad M Najm; Richard C Burgess; Andreas V Alexopoulos Journal: Brain Date: 2016-11-01 Impact factor: 13.501
Authors: Naoaki Tanaka; Christos Papadelis; Eleonora Tamilia; Michel AlHilani; Joseph R Madsen; Phillip L Pearl; Steven M Stufflebeam Journal: Pediatr Neurol Date: 2018-03-15 Impact factor: 3.372
Authors: Z Irene Wang; Stephen E Jones; Zeenat Jaisani; Imad M Najm; Richard A Prayson; Richard C Burgess; Balu Krishnan; Aleksandar Ristic; Chong H Wong; William Bingaman; Jorge A Gonzalez-Martinez; Andreas V Alexopoulos Journal: Ann Neurol Date: 2015-04-23 Impact factor: 10.422
Authors: Z Irene Wang; P Suwanpakdee; S E Jones; Z Jaisani; Ahsan N V Moosa; I M Najm; F von Podewils; R C Burgess; B Krishnan; R A Prayson; J A Gonzalez-Martinez; W Bingaman; A V Alexopoulos Journal: J Neurol Date: 2016-06-13 Impact factor: 4.849
Authors: Irene Wang; Sehong Oh; Ingmar Blümcke; Roland Coras; Balu Krishnan; Sanghoon Kim; Aaron McBride; Olesya Grinenko; Yicong Lin; Margit Overmyer; Tin Tun Aung; Mark Lowe; Mykol Larvie; Andreas V Alexopoulos; William Bingaman; Jorge A Gonzalez-Martinez; Imad Najm; Stephen E Jones Journal: Epilepsia Date: 2020-09-19 Impact factor: 5.864