Saramati Narasimhan1,2,3,4, Hernán F J González2,3,4, Graham W Johnson2,3,4, Kristin E Wills1,2,3, Danika L Paulo1, Victoria L Morgan1,2,3,4, Dario J Englot1,2,3,4,5. 1. 1Department of Neurological Surgery and. 2. 2Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center. 3. 3Vanderbilt Institute for Surgery and Engineering. 4. 4Department of Biomedical, and. 5. 5Department of Electrical Engineering and Computer Science at Vanderbilt University, Nashville, Tennessee.
Abstract
OBJECTIVE: The most common surgically treatable epilepsy syndrome is mesial temporal lobe epilepsy (mTLE). Preoperative noninvasive lateralization of mTLE is challenging in part due to rapid contralateral seizure spread. Abnormal connections in both the mesial temporal lobe and resting-state networks have been described in mTLE, but it is unclear if connectivity between these networks may aid in lateralization. METHODS: In 52 patients with left mTLE (LmTLE) or right mTLE (RmTLE) and 52 matched control subjects, the authors acquired 20 minutes of resting-state functional MRI (fMRI) and evaluated functional connectivity of bilateral hippocampi and amygdalae with selected resting-state networks. They used Pearson correlation, network-based statistic, and dynamic causal modeling. Also, to evaluate the clinical utility of a resting-state connectivity model in lateralizing unilateral presurgical mTLE patients, they used receiver operating characteristic curve analysis. RESULTS: RmTLE patients demonstrated decreased nondirected connectivity between the right hippocampus and default mode network compared with LmTLE patients and control subjects. Network-based statistic analysis revealed that the network with most decreased connectivity that distinguished LmTLE from RmTLE patients included the right hippocampus and amygdala, right lateral orbitofrontal cortices, and bilateral inferior parietal lobules, precuneus, and medial orbitofrontal cortices. Dynamic causal modeling analysis revealed that cross-hemispheric connectivity between hippocampi and amygdalae was predominantly inward toward the epileptogenic side. A regression model incorporating these connectivity patterns was used to accurately lateralize mTLE patients with an area under the receiver operating characteristic curve of 0.87. CONCLUSIONS: Evaluating fMRI connectivity between mesial temporal structures and default mode network may aid in mTLE lateralization, reduce need for intracranial monitoring, and guide surgical planning.
OBJECTIVE: The most common surgically treatable epilepsy syndrome is mesial temporal lobe epilepsy (mTLE). Preoperative noninvasive lateralization of mTLE is challenging in part due to rapid contralateral seizure spread. Abnormal connections in both the mesial temporal lobe and resting-state networks have been described in mTLE, but it is unclear if connectivity between these networks may aid in lateralization. METHODS: In 52 patients with left mTLE (LmTLE) or right mTLE (RmTLE) and 52 matched control subjects, the authors acquired 20 minutes of resting-state functional MRI (fMRI) and evaluated functional connectivity of bilateral hippocampi and amygdalae with selected resting-state networks. They used Pearson correlation, network-based statistic, and dynamic causal modeling. Also, to evaluate the clinical utility of a resting-state connectivity model in lateralizing unilateral presurgical mTLE patients, they used receiver operating characteristic curve analysis. RESULTS: RmTLE patients demonstrated decreased nondirected connectivity between the right hippocampus and default mode network compared with LmTLE patients and control subjects. Network-based statistic analysis revealed that the network with most decreased connectivity that distinguished LmTLE from RmTLE patients included the right hippocampus and amygdala, right lateral orbitofrontal cortices, and bilateral inferior parietal lobules, precuneus, and medial orbitofrontal cortices. Dynamic causal modeling analysis revealed that cross-hemispheric connectivity between hippocampi and amygdalae was predominantly inward toward the epileptogenic side. A regression model incorporating these connectivity patterns was used to accurately lateralize mTLE patients with an area under the receiver operating characteristic curve of 0.87. CONCLUSIONS: Evaluating fMRI connectivity between mesial temporal structures and default mode network may aid in mTLE lateralization, reduce need for intracranial monitoring, and guide surgical planning.
Authors: Kerry A Vaughan; Christian Lopez Ramos; Vivek P Buch; Rania A Mekary; Julia R Amundson; Meghal Shah; Abbas Rattani; Michael C Dewan; Kee B Park Journal: J Neurosurg Date: 2018-09-01 Impact factor: 5.115
Authors: Hernán F J González; Srijata Chakravorti; Sarah E Goodale; Kanupriya Gupta; Daniel O Claassen; Benoit Dawant; Victoria L Morgan; Dario J Englot Journal: J Neurol Neurosurg Psychiatry Date: 2019-05-23 Impact factor: 10.154
Authors: Victoria L Morgan; Baxter P Rogers; Hasan H Sonmezturk; John C Gore; Bassel Abou-Khalil Journal: Epilepsia Date: 2011-07-29 Impact factor: 5.864
Authors: Patrick Kwan; Alexis Arzimanoglou; Anne T Berg; Martin J Brodie; W Allen Hauser; Gary Mathern; Solomon L Moshé; Emilio Perucca; Samuel Wiebe; Jacqueline French Journal: Epilepsia Date: 2009-11-03 Impact factor: 5.864