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Vermeulen I, Rodriguez-Alvarez N, François L, Viot D, Poosti F, Aronica E, Dedeurwaerdere S, Barton P, Cillero-Pastor B, Heeren RMA. Spatial omics reveals molecular changes in focal cortical dysplasia type II. Neurobiol Dis 2024; 195:106491. [PMID: 38575092 DOI: 10.1016/j.nbd.2024.106491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/14/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024] Open
Abstract
Focal cortical dysplasia (FCD) represents a group of diverse localized cortical lesions that are highly epileptogenic and occur due to abnormal brain development caused by genetic mutations, involving the mammalian target of rapamycin (mTOR). These somatic mutations lead to mosaicism in the affected brain, posing challenges to unravel the direct and indirect functional consequences of these mutations. To comprehensively characterize the impact of mTOR mutations on the brain, we employed here a multimodal approach in a preclinical mouse model of FCD type II (Rheb), focusing on spatial omics techniques to define the proteomic and lipidomic changes. Mass Spectrometry Imaging (MSI) combined with fluorescence imaging and label free proteomics, revealed insight into the brain's lipidome and proteome within the FCD type II affected region in the mouse model. MSI visualized disrupted neuronal migration and differential lipid distribution including a reduction in sulfatides in the FCD type II-affected region, which play a role in brain myelination. MSI-guided laser capture microdissection (LMD) was conducted on FCD type II and control regions, followed by label free proteomics, revealing changes in myelination pathways by oligodendrocytes. Surgical resections of FCD type IIb and postmortem human cortex were analyzed by bulk transcriptomics to unravel the interplay between genetic mutations and molecular changes in FCD type II. Our comparative analysis of protein pathways and enriched Gene Ontology pathways related to myelination in the FCD type II-affected mouse model and human FCD type IIb transcriptomics highlights the animal model's translational value. This dual approach, including mouse model proteomics and human transcriptomics strengthens our understanding of the functional consequences arising from somatic mutations in FCD type II, as well as the identification of pathways that may be used as therapeutic strategies in the future.
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Affiliation(s)
- Isabeau Vermeulen
- Maastricht MultiModal Molecular Imaging Institute (M4i), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | | | - Liesbeth François
- UCB Pharma, Chemin du Foriest 1, 1420 Braine-l'Alleud, Walloon Region, Belgium
| | - Delphine Viot
- UCB Pharma, Chemin du Foriest 1, 1420 Braine-l'Alleud, Walloon Region, Belgium
| | - Fariba Poosti
- UCB Pharma, Chemin du Foriest 1, 1420 Braine-l'Alleud, Walloon Region, Belgium
| | - Eleonora Aronica
- Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Department of (Neuro)Pathology, De Boelelaan 1108, 1081 HV Amsterdam, the Netherlands; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 3, 2103 SW Heemstede, the Netherlands
| | | | - Patrick Barton
- UCB Pharma, 216 Bath Rd, Slough, SL1 3WE Berkshire, United Kingdom
| | - Berta Cillero-Pastor
- Maastricht MultiModal Molecular Imaging Institute (M4i), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands; Cell Biology-Inspired Tissue Engineering (cBITE), MERLN, Maastricht University, Universiteitssingel 40, 6229 ET Maastricht, Netherlands
| | - Ron M A Heeren
- Maastricht MultiModal Molecular Imaging Institute (M4i), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.
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Yang J, Li D, Li Z, Wang H, Dong Y, Zhang X. Analysis of predictive factors in surgical treatment of intractable epilepsy caused by focal cortical dysplasia in children. Int J Neurosci 2024:1-7. [PMID: 38557439 DOI: 10.1080/00207454.2024.2338253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE This study aims to analyze key factors affecting the surgical outcome of children with intractable epilepsy caused by focal cortical dysplasia, providing more effective clinical guidance. METHODS We conducted a study from March 2019 to February 2021, selecting 80 children with intractable epilepsy caused by focal cortical dysplasia who underwent surgical treatment. Comprehensive inclusion criteria were met. We collected general information and treatment outcomes before and after surgery, with a two-year postoperative follow-up. Patients were categorized into good and poor outcome groups based on outcomes. Various factors including pathological types, age of onset, seizure frequency, and extent of resection were selected as variables. Logistic regression analysis investigated predictive factors. RESULTS Engel class I included 53 cases, class II had 16 cases, class III had 9 cases, and class IV had 2 cases. Thus, 53 cases were in the good outcome group, and 27 in the poor outcome group. General data showed no significant differences between the groups (p > 0.05). Single-factor analysis revealed statistically significant risk factors: FCD classification, MRI results, age of onset, seizure frequency, and extent of resection (p < 0.05). Logistic multifactor analysis indicated seizure frequency. acute postoperative seizures (APSO) and extent of resection as independent influencing factors (p < 0.05). CONCLUSION Seizure frequency, extent of resection, and APSO are key independent factors for surgical outcome in children with intractable epilepsy caused by focal cortical dysplasia. Clinicians should consider these factors when planning treatment to improve success rates and outcome, enhancing quality of life for affected children.
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Affiliation(s)
- Jixue Yang
- The Third Affiliated Hospital, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongming Li
- The Third Affiliated Hospital, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhentao Li
- The Third Affiliated Hospital, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haiyan Wang
- The Third Affiliated Hospital, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Dong
- The Third Affiliated Hospital, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoli Zhang
- The Third Affiliated Hospital, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Casella C, Vecchiato K, Cromb D, Guo Y, Winkler AM, Hughes E, Dillon L, Green E, Colford K, Egloff A, Siddiqui A, Price A, Grande LC, Wood TC, Malik S, Teixeira RPAG, Carmichael DW, O'Muircheartaigh J. Widespread, depth-dependent cortical microstructure alterations in pediatric focal epilepsy. Epilepsia 2024; 65:739-752. [PMID: 38088235 DOI: 10.1111/epi.17861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Tissue abnormalities in focal epilepsy may extend beyond the presumed focus. The underlying pathophysiology of these broader changes is unclear, and it is not known whether they result from ongoing disease processes or treatment-related side effects, or whether they emerge earlier. Few studies have focused on the period of onset for most focal epilepsies, childhood. Fewer still have utilized quantitative magnetic resonance imaging (MRI), which may provide a more sensitive and interpretable measure of tissue microstructural change. Here, we aimed to determine common spatial modes of changes in cortical architecture in children with heterogeneous drug-resistant focal epilepsy and, secondarily, whether changes were related to disease severity. METHODS To assess cortical microstructure, quantitative T1 and T2 relaxometry (qT1 and qT2) was measured in 43 children with drug-resistant focal epilepsy (age range = 4-18 years) and 46 typically developing children (age range = 2-18 years). We assessed depth-dependent qT1 and qT2 values across the neocortex, as well as their gradient of change across cortical depths. We also determined whether global changes seen in group analyses were driven by focal pathologies in individual patients. Finally, as a proof-of-concept, we trained a classifier using qT1 and qT2 gradient maps from patients with radiologically defined abnormalities (MRI positive) and healthy controls, and tested whether this could classify patients without reported radiological abnormalities (MRI negative). RESULTS We uncovered depth-dependent qT1 and qT2 increases in widespread cortical areas in patients, likely representing microstructural alterations in myelin or gliosis. Changes did not correlate with disease severity measures, suggesting they may represent antecedent neurobiological alterations. Using a classifier trained with MRI-positive patients and controls, sensitivity was 71.4% at 89.4% specificity on held-out MRI-negative patients. SIGNIFICANCE These findings suggest the presence of a potential imaging endophenotype of focal epilepsy, detectable irrespective of radiologically identified abnormalities.
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Affiliation(s)
- Chiara Casella
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Katy Vecchiato
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Yourong Guo
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Anderson M Winkler
- Department of Human Genetics, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Emer Hughes
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Louise Dillon
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Elaine Green
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Kathleen Colford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Alexia Egloff
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Ata Siddiqui
- Department of Radiology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Anthony Price
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Lucilio Cordero Grande
- Department of Biomedical Engineering, King's College London, London, UK
- Biomedical Image Technologies, Telecommunication Engineering School (ETSIT), Technical University of Madrid, Bioengineering, Biomaterials and Nanomedicine Networking Biomedical Research Centre, National Institute of Health Carlos III, Madrid, Spain
| | - Tobias C Wood
- Department of Neuroimaging, King's College London, London, UK
| | - Shaihan Malik
- Department of Biomedical Engineering, King's College London, London, UK
| | | | | | - Jonathan O'Muircheartaigh
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department for Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Medical Research Council (MRC) Centre for Neurodevelopmental Disorders, London, UK
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Rodrigo Marinowic D, Bottega Pazzin D, Prates da Cunha de Azevedo S, Pinzetta G, Victor Machado de Souza J, Tonon Schneider F, Thor Ramos Previato T, Jean Varella de Oliveira F, Costa Da Costa J. Epileptogenesis and drug-resistant in focal cortical dysplasias: Update on clinical, cellular, and molecular markers. Epilepsy Behav 2024; 150:109565. [PMID: 38070410 DOI: 10.1016/j.yebeh.2023.109565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 01/14/2024]
Abstract
Focal cortical dysplasia (FCD) is a cortical malformation in brain development and is considered as one of the major causes of drug-resistant epilepsiesin children and adults. The pathogenesis of FCD is yet to be fully understood. Imaging markers such as MRI are currently the surgeons major obstacle due to the difficulty in delimiting the precise dysplasic area and a mosaic brain where there is epileptogenic tissue invisible to MRI. Also increased gene expression and activity may be responsible for the alterations in cell proliferation, migration, growth, and survival. Altered expressions were found, particularly in the PI3K/AKT/mTOR pathway. Surgery is still considered the most effective treatment option, due to drug-resistance, and up to 60 % of patients experience complete seizure control, varying according to the type and location of FCD. Both genetic and epigenetic factors may be involved in the pathogenesis of FCD, and there is no conclusive evidence whether these alterations are inherited or have an environmental origin.
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Affiliation(s)
- Daniel Rodrigo Marinowic
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Graduate Program in Medicine and Health Sciences, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
| | - Douglas Bottega Pazzin
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Graduate Program in Medicine and Health Sciences, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Giulia Pinzetta
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - João Victor Machado de Souza
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernando Tonon Schneider
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Thales Thor Ramos Previato
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Graduate Program in Medicine and Health Sciences, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fábio Jean Varella de Oliveira
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Graduate Program in Medicine and Health Sciences, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jaderson Costa Da Costa
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Graduate Program in Medicine and Health Sciences, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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Fountain C, Ghuman H, Paldino M, Tamber M, Panigrahy A, Modo M. Acquisition and Analysis of Excised Neocortex from Pediatric Patients with Focal Cortical Dysplasia Using Mesoscale Diffusion MRI. Diagnostics (Basel) 2023; 13:1529. [PMID: 37174921 PMCID: PMC10177920 DOI: 10.3390/diagnostics13091529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/01/2023] [Accepted: 04/15/2023] [Indexed: 05/15/2023] Open
Abstract
Non-invasive classification of focal cortical dysplasia (FCD) subtypes remains challenging from a radiology perspective. Quantitative imaging biomarkers (QIBs) have the potential to distinguish subtypes that lack pathognomonic features and might help in defining the extent of abnormal connectivity associated with each FCD subtype. A key motivation of diagnostic imaging is to improve the localization of a "lesion" that can guide the surgical resection of affected tissue, which is thought to cause seizures. Conversely, surgical resections to eliminate or reduce seizures provided unique opportunities to develop magnetic resonance imaging (MRI)-based QIBs by affording long scan times to evaluate multiple contrast mechanisms at the mesoscale (0.5 mm isotropic voxel dimensions). Using ex vivo hybrid diffusion tensor imaging on a 9.4 T MRI scanner, the grey to white matter ratio of scalar indices was lower in the resected middle temporal gyrus (MTG) of two neuropathologically confirmed cases of FCD compared to non-diseased control postmortem fixed temporal lobes. In contrast, fractional anisotropy was increased within FCD and also adjacent white matter tracts. Connectivity (streamlines/mm3) in the MTG was higher in FCD, suggesting that an altered connectivity at the lesion locus can potentially provide a tangible QIB to distinguish and characterize FCD abnormalities. However, as illustrated here, a major challenge for a robust tractographical comparison lies in the considerable differences in the ex vivo processing of bioptic and postmortem samples. Mesoscale diffusion MRI has the potential to better define and characterize epileptic tissues obtained from surgical resection to advance our understanding of disease etiology and treatment.
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Affiliation(s)
- Chandler Fountain
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St, Chartlottesville, VA 22903, USA
| | - Harmanvir Ghuman
- Department of Bioengineering, University of Pittsburgh, 302 Benedum Hall, 3700 O’Hara Street, Pititsburgh, PA 15260, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219, USA
| | - Michael Paldino
- Department of Radiology, University of Pittsburgh, PUH Suite E204, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Mandeep Tamber
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, Suite B 400, Pittsburgh, PA 15213, USA
| | - Ashok Panigrahy
- Department of Radiology, University of Pittsburgh, PUH Suite E204, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Michel Modo
- Department of Bioengineering, University of Pittsburgh, 302 Benedum Hall, 3700 O’Hara Street, Pititsburgh, PA 15260, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219, USA
- Department of Radiology, University of Pittsburgh, PUH Suite E204, 200 Lothrop Street, Pittsburgh, PA 15213, USA
- Centre for the Neural Basis of Behavior, University of Pittsburgh and Carnegie Mellon University, 4074 Biomedical Science Tower 3, Pittsburgh, PA 15261, USA
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Choi JY, Hu S, Su TY, Murakami H, Tang Y, Blümcke I, Najm I, Sakaie K, Jones S, Griswold M, Wang ZI, Ma D. Normative quantitative relaxation atlases for characterization of cortical regions using magnetic resonance fingerprinting. Cereb Cortex 2023; 33:3562-3574. [PMID: 35945683 PMCID: PMC10068276 DOI: 10.1093/cercor/bhac292] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/14/2022] Open
Abstract
Quantitative magnetic resonance (MR) has been used to study cyto- and myelo-architecture of the human brain non-invasively. However, analyzing brain cortex using high-resolution quantitative MR acquisition can be challenging to perform using 3T clinical scanners. MR fingerprinting (MRF) is a highly efficient and clinically feasible quantitative MR technique that simultaneously provides T1 and T2 relaxation maps. Using 3D MRF from 40 healthy subjects (mean age = 25.6 ± 4.3 years) scanned on 3T magnetic resonance imaging, we generated whole-brain gyral-based normative MR relaxation atlases and investigated cortical-region-based T1 and T2 variations. Gender and age dependency of T1 and T2 variations were additionally analyzed. The coefficient of variation of T1 and T2 for each cortical-region was 3.5% and 7.3%, respectively, supporting low variability of MRF measurements across subjects. Significant differences in T1 and T2 were identified among 34 brain regions (P < 0.001), lower in the precentral, postcentral, paracentral lobule, transverse temporal, lateral occipital, and cingulate areas, which contain sensorimotor, auditory, visual, and limbic functions. Significant correlations were identified between age and T1 and T2 values. This study established whole-brain MRF T1 and T2 atlases of healthy subjects using a clinical 3T scanner, which can provide a quantitative and region-specific baseline for future brain studies and pathology detection.
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Affiliation(s)
- Joon Yul Choi
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44106, United States
| | - Siyuan Hu
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, United States
| | - Ting-Yu Su
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44106, United States
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, United States
| | - Hiroatsu Murakami
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44106, United States
| | - Yingying Tang
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44106, United States
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Ln, Wuhou District, Chengdu, Sichuan 610041, China
| | - Ingmar Blümcke
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44106, United States
- Imaging Institute, Cleveland Clinic, 1950 E 89th St U Bldg, Cleveland, OH 44195, United States
| | - Imad Najm
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44106, United States
| | - Ken Sakaie
- Department of Neuropathology, University of Erlangen, Schlobplatz 4, Erlangen 91054, Germany
| | - Stephen Jones
- Department of Neuropathology, University of Erlangen, Schlobplatz 4, Erlangen 91054, Germany
| | - Mark Griswold
- Department of Radiology, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106, United States
| | - Zhong Irene Wang
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44106, United States
| | - Dan Ma
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, United States
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Sufianov A, Simfukwe K, Iakimov IA, Sufianov RA, Rassi MS, Mastronardi L, Borba LAB, Campero A, Rangel CC, Baldoncini M. Usefulness of Intraoperative ultrasound for cortical dysplasia type I treatment - A single-center experience. Surg Neurol Int 2023; 14:62. [PMID: 36895230 PMCID: PMC9990806 DOI: 10.25259/sni_926_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/13/2022] [Indexed: 03/11/2023] Open
Abstract
Background Focal cortical dysplasias (FCD) cause a subgroup of malformations of cortical development that has been closely linked to cause drug intractable epilepsy. Attaining adequate and safe resection of the dysplastic lesion has proved to be a viable option to archive meaningful seizure control. Of the three types of FCD (types I, II, and III), type I has the least detectable architectural and radiological abnormalities. This makes it challenging (preoperatively and intraoperatively) to achieve adequate resection. Intraoperatively, ultrasound navigation has proven an effective tool during the resection of these lesions. We evaluate our institutional experience in surgical management of FCD type I using intraoperative ultrasound (IoUS). Methods Our work is a retrospective and descriptive study, where we analyzed patients diagnosed with refractory epilepsy who underwent IoUS-guided epileptogenic tissue resection. The surgical cases analyzed were from January 2015 to June 2020 at the Federal Center of Neurosurgery, Tyumen, only patients with histological confirmation of postoperative CDF type I were included in the study. Results Of the 11 patients with histologically diagnosed FCD type I, 81.8% of the patients postoperatively had a significant reduction in seizure frequency (Engel outcome I-II). Conclusion IoUS is a critical tool for detecting and delineating FCD type I lesions, which is necessary for effective post-epilepsy surgery results.
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Affiliation(s)
- Albert Sufianov
- Department of Neurosurgery, Federal Center of Neurosurgery, Tyumen, Russian Federation
| | - Keith Simfukwe
- Department of Neurosurgery, First Moscow Medical University, Moscow, Russian Federation
| | - Iurii A Iakimov
- Department of Neurosurgery, First Moscow Medical University, Tyumen, Russian Federation
| | - Rinat A Sufianov
- Department of Neurosurgery, First Moscow Medical University, Moscow, Russian Federation
| | - Marcio S Rassi
- Department of Neurosurgery, Camargo Cancer Center, Sao Paulo, Brazil
| | | | - Luis A B Borba
- Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Brazil
| | - Alvaro Campero
- Department of Neurosurgery, Hospital Padilla de Tucuman, Tucuman, Mexico
| | - Carlos Castillo Rangel
- Department of Neurosurgery, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Matias Baldoncini
- Department of Neurosurgery, San Fernando Hospital, San Fernando, Buenos Aires, Argentina
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Tang Y, Blümcke I, Su TY, Choi JY, Krishnan B, Murakami H, Alexopoulos AV, Najm IM, Jones SE, Wang ZI. Black Line Sign in Focal Cortical Dysplasia IIB: A 7T MRI and Electroclinicopathologic Study. Neurology 2022; 99:e616-e626. [PMID: 35940890 PMCID: PMC9442623 DOI: 10.1212/wnl.0000000000200702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES We aim to provide detailed imaging-electroclinicopathologic characterization of the black line sign, a novel MRI marker for focal cortical dysplasia (FCD) IIB. METHODS 7T T2*-weighted gradient-echo (T2*w-GRE) images were retrospectively reviewed in a consecutive cohort of patients with medically intractable epilepsy with pathology-proven FCD II, for the occurrence of the black line sign. We examined the overlap between the black line region and the seizure-onset zone (SOZ) defined by intracranial EEG (ICEEG) and additionally assessed whether complete inclusion of the black line region in the surgical resection was associated with postoperative seizure freedom. The histopathologic specimen was aligned with the MRI to investigate the pathologic underpinning of the black line sign. Region-of-interest-based quantitative MRI (qMRI) analysis on the 7T T1 map was performed in the black line region, entire lesional gray matter (GM), and contralateral/ipsilateral normal gray and white matter (WM). RESULTS We included 20 patients with FCD II (14 IIB and 6 IIA). The black line sign was identified in 12/14 (85.7%) of FCD IIB and 0/6 of FCD IIA on 7T T2*w-GRE. The black line region was highly concordant with the ICEEG-defined SOZ (5/7 complete and 2/7 partial overlap). Seizure freedom was seen in 8/8 patients whose black line region was completely included in the surgical resection; in the 2 patients whose resection did not completely include the black line region, both had recurring seizures. Inclusion of the black line region in the surgical resection was significantly associated with seizure freedom (p = 0.02). QMRI analyses showed that the T1 mean value of the black line region was significantly different from the WM (p < 0.001), but similar to the GM. Well-matched histopathologic slices in one case revealed accumulated dysmorphic neurons and balloon cells in the black line region. DISCUSSION The black line sign may serve as a noninvasive marker for FCD IIB. Both MRI-pathology and qMRI analyses suggest that the black line region was an abnormal GM component within the FCD. Being highly concordant with ICEEG-defined SOZ and significantly associated with seizure freedom when included in resection, the black line sign may contribute to the planning of ICEEG/surgery of patients with medically intractable epilepsy with FCD IIB. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in individuals with intractable focal epilepsy undergoing resection who have a 7T MRI with adequate image quality, the presence of the black line sign may suggest FCD IIB, be concordant with SOZ from ICEEG, and be associated with more seizure freedom if fully included in resection.
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Affiliation(s)
- Yingying Tang
- From the Department of Neurology (Y.T.), West China Hospital of Sichuan University, Chengdu, Sichuan, China; Charles Shor Epilepsy Center (Y.T., I.B., T.-Y.S., J.Y.C., B.K., H.M., A.V.A., I.M.N., Z.I.W.), Cleveland Clinic; Department of Neuropathology (I.B.), University of Erlangen, Germany; Department of Biomedical Engineering (T.-Y.S.), Case Western Reserve University; and Imaging Institute (S.E.J.), Cleveland Clinic, OH
| | - Ingmar Blümcke
- From the Department of Neurology (Y.T.), West China Hospital of Sichuan University, Chengdu, Sichuan, China; Charles Shor Epilepsy Center (Y.T., I.B., T.-Y.S., J.Y.C., B.K., H.M., A.V.A., I.M.N., Z.I.W.), Cleveland Clinic; Department of Neuropathology (I.B.), University of Erlangen, Germany; Department of Biomedical Engineering (T.-Y.S.), Case Western Reserve University; and Imaging Institute (S.E.J.), Cleveland Clinic, OH
| | - Ting-Yu Su
- From the Department of Neurology (Y.T.), West China Hospital of Sichuan University, Chengdu, Sichuan, China; Charles Shor Epilepsy Center (Y.T., I.B., T.-Y.S., J.Y.C., B.K., H.M., A.V.A., I.M.N., Z.I.W.), Cleveland Clinic; Department of Neuropathology (I.B.), University of Erlangen, Germany; Department of Biomedical Engineering (T.-Y.S.), Case Western Reserve University; and Imaging Institute (S.E.J.), Cleveland Clinic, OH
| | - Joon Yul Choi
- From the Department of Neurology (Y.T.), West China Hospital of Sichuan University, Chengdu, Sichuan, China; Charles Shor Epilepsy Center (Y.T., I.B., T.-Y.S., J.Y.C., B.K., H.M., A.V.A., I.M.N., Z.I.W.), Cleveland Clinic; Department of Neuropathology (I.B.), University of Erlangen, Germany; Department of Biomedical Engineering (T.-Y.S.), Case Western Reserve University; and Imaging Institute (S.E.J.), Cleveland Clinic, OH
| | - Balu Krishnan
- From the Department of Neurology (Y.T.), West China Hospital of Sichuan University, Chengdu, Sichuan, China; Charles Shor Epilepsy Center (Y.T., I.B., T.-Y.S., J.Y.C., B.K., H.M., A.V.A., I.M.N., Z.I.W.), Cleveland Clinic; Department of Neuropathology (I.B.), University of Erlangen, Germany; Department of Biomedical Engineering (T.-Y.S.), Case Western Reserve University; and Imaging Institute (S.E.J.), Cleveland Clinic, OH
| | - Hiroatsu Murakami
- From the Department of Neurology (Y.T.), West China Hospital of Sichuan University, Chengdu, Sichuan, China; Charles Shor Epilepsy Center (Y.T., I.B., T.-Y.S., J.Y.C., B.K., H.M., A.V.A., I.M.N., Z.I.W.), Cleveland Clinic; Department of Neuropathology (I.B.), University of Erlangen, Germany; Department of Biomedical Engineering (T.-Y.S.), Case Western Reserve University; and Imaging Institute (S.E.J.), Cleveland Clinic, OH
| | - Andreas V Alexopoulos
- From the Department of Neurology (Y.T.), West China Hospital of Sichuan University, Chengdu, Sichuan, China; Charles Shor Epilepsy Center (Y.T., I.B., T.-Y.S., J.Y.C., B.K., H.M., A.V.A., I.M.N., Z.I.W.), Cleveland Clinic; Department of Neuropathology (I.B.), University of Erlangen, Germany; Department of Biomedical Engineering (T.-Y.S.), Case Western Reserve University; and Imaging Institute (S.E.J.), Cleveland Clinic, OH
| | - Imad M Najm
- From the Department of Neurology (Y.T.), West China Hospital of Sichuan University, Chengdu, Sichuan, China; Charles Shor Epilepsy Center (Y.T., I.B., T.-Y.S., J.Y.C., B.K., H.M., A.V.A., I.M.N., Z.I.W.), Cleveland Clinic; Department of Neuropathology (I.B.), University of Erlangen, Germany; Department of Biomedical Engineering (T.-Y.S.), Case Western Reserve University; and Imaging Institute (S.E.J.), Cleveland Clinic, OH
| | - Stephen E Jones
- From the Department of Neurology (Y.T.), West China Hospital of Sichuan University, Chengdu, Sichuan, China; Charles Shor Epilepsy Center (Y.T., I.B., T.-Y.S., J.Y.C., B.K., H.M., A.V.A., I.M.N., Z.I.W.), Cleveland Clinic; Department of Neuropathology (I.B.), University of Erlangen, Germany; Department of Biomedical Engineering (T.-Y.S.), Case Western Reserve University; and Imaging Institute (S.E.J.), Cleveland Clinic, OH
| | - Zhong Irene Wang
- From the Department of Neurology (Y.T.), West China Hospital of Sichuan University, Chengdu, Sichuan, China; Charles Shor Epilepsy Center (Y.T., I.B., T.-Y.S., J.Y.C., B.K., H.M., A.V.A., I.M.N., Z.I.W.), Cleveland Clinic; Department of Neuropathology (I.B.), University of Erlangen, Germany; Department of Biomedical Engineering (T.-Y.S.), Case Western Reserve University; and Imaging Institute (S.E.J.), Cleveland Clinic, OH.
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9
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Tang Y, Su TY, Choi JY, Hu S, Wang X, Sakaie K, Murakami H, Alexopoulos A, Griswold M, Jones S, Najm I, Ma D, Wang ZI. Characterizing Thalamic and Basal Ganglia Nuclei in Medically Intractable Focal Epilepsy by MR Fingerprinting. Epilepsia 2022; 63:1998-2010. [PMID: 35661353 DOI: 10.1111/epi.17318] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/11/2022] [Accepted: 06/02/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Magnetic resonance fingerprinting (MRF) is a novel, quantitative and noninvasive technique to measure brain tissue properties. We aim to use MRF for characterizing normal-appearing thalamic and basal ganglia nuclei in the epileptic brain. METHODS A 3D MRF protocol (1mm3 isotropic resolution) was acquired from 48 patients with unilateral medically refractory focal epilepsy and 39 healthy controls (HCs). Whole-brain T1 and T2 maps (containing T1 and T2 relaxation times) were reconstructed for each subject. Ten subcortical nuclei in the thalamus and basal ganglia were segmented as regions of interest (ROIs), within which the mean T1 and T2 values, as well as their coefficient of variation (CV) were compared between the patients and HCs at group level. Subgroup and correlation analyses were performed to examine the relationship between significant MRF measures and various clinical characteristics. Using significantly abnormal MRF measures from the group-level analyses, support vector machine (SVM) and logistic regression machine learning models were built and tested with 5-fold and 10-fold cross-validations, to separate patients from HCs, and to separate patients with left-sided and right-sided epilepsy, at individual level. RESULTS MRF revealed increased T1 mean value in the ipsilateral thalamus and nucleus accumbens; increased T1 CV in bilateral thalamus, bilateral pallidum, and ipsilateral caudate; and increased T2 CV in the ipsilateral thalamus in patients compared to HCs (P<0.05, FDR corrected). The SVM classifier produced 78.2% average accuracy to separate individual patients from HCs, with AUC of 0.83. The logistic regression classifier produced 67.4% average accuracy to separate patients with left-sided and right-sided epilepsy, with AUC of 0.72. SIGNIFICANCE MRF revealed bilateral tissue-property changes in the normal-appearing thalamus and basal ganglia, with ipsilateral predominance and thalamic preference, suggesting subcortical involvement/impairment in patients with medically intractable focal epilepsy. The individual-level performance of the MRF-based machine-learning models suggests potential opportunities for predicting lateralization.
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Affiliation(s)
- Yingying Tang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Ting Yu Su
- Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA.,Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Joon Yul Choi
- Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Siyuan Hu
- Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Xiaofeng Wang
- Quantitative Health Science, Cleveland Clinic, Cleveland, OH, USA
| | - Ken Sakaie
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Mark Griswold
- Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Stephen Jones
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Imad Najm
- Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Dan Ma
- Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Zhong Irene Wang
- Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
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10
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MRI of focal cortical dysplasia. Neuroradiology 2021; 64:443-452. [PMID: 34839379 PMCID: PMC8850246 DOI: 10.1007/s00234-021-02865-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/17/2021] [Indexed: 11/09/2022]
Abstract
Focal cortical dysplasia (FCD) are histopathologically categorized in ILAE type I to III. Mild malformations of cortical development (mMCD) including those with oligodendroglial hyperplasia (MOGHE) are to be integrated into this classification yet. Only FCD type II have distinctive MRI and molecular genetics alterations so far. Subtle FCD including FCD type II located in the depth of a sulcus are often overlooked requiring the use of dedicated sequences (MP2RAGE, FLAWS, EDGE) and/or voxel (VBM)- or surface-based (SBM) postprocessing. The added value of 7 Tesla MRI has to be proven yet.
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11
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Saute RL, Peixoto-Santos JE, Velasco TR, Leite JP. Improving surgical outcome with electric source imaging and high field magnetic resonance imaging. Seizure 2021; 90:145-154. [PMID: 33608134 DOI: 10.1016/j.seizure.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 12/14/2022] Open
Abstract
While most patients with focal epilepsy present with clear structural abnormalities on standard, 1.5 or 3 T MRI, some patients are MRI-negative. For those, quantitative MRI techniques, such as volumetry, voxel-based morphometry, and relaxation time measurements can aid in finding the epileptogenic focus. High-field MRI, just recently approved for clinical use by the FDA, increases the resolution and, in several publications, was shown to improve the detection of focal cortical dysplasias and mild cortical malformations. For those cases without any tissue abnormality in neuroimaging, even at 7 T, scalp EEG alone is insufficient to delimitate the epileptogenic zone. They may benefit from the use of high-density EEG, in which the increased number of electrodes helps improve spatial sampling. The spatial resolution of even low-density EEG can benefit from electric source imaging techniques, which map the source of the recorded abnormal activity, such as interictal epileptiform discharges, focal slowing, and ictal rhythm. These EEG techniques help localize the irritative, functional deficit, and seizure-onset zone, to better estimate the epileptogenic zone. Combining those technologies allows several drug-resistant cases to be submitted to surgery, increasing the odds of seizure freedom and providing a must needed hope for patients with epilepsy.
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Affiliation(s)
- Ricardo Lutzky Saute
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Brazil
| | - Jose Eduardo Peixoto-Santos
- Discipline of Neuroscience, Department of Neurology and Neurosurgery, Paulista School of Medicine, Unifesp, Brazil
| | - Tonicarlo R Velasco
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Brazil
| | - Joao Pereira Leite
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Brazil.
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12
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Bartoňová M, Bartoň M, Říha P, Vojtíšek L, Brázdil M, Rektor I. The benefit of the diffusion kurtosis imaging in presurgical evaluation in patients with focal MR-negative epilepsy. Sci Rep 2021; 11:14208. [PMID: 34244544 PMCID: PMC8270902 DOI: 10.1038/s41598-021-92804-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/15/2021] [Indexed: 02/06/2023] Open
Abstract
The effectivity of diffusion-weighted MRI methods in detecting the epileptogenic zone (EZ) was tested. Patients with refractory epilepsy (N=25) who subsequently underwent resective surgery were recruited. First, the extent of white matter (WM) asymmetry from mean kurtosis (MK) was calculated in order to detect the lobe with the strongest impairment. Second, a newly developed metric was used, reflecting a selection of brain areas with concurrently increased mean Diffusivity, reduced fractional Anisotropy, and reduced mean Kurtosis (iDrArK). A two-step EZ detection was performed as (1) lobe-specific detection, (2) iDrArK voxel-wise detection (with a possible lobe-specific restriction if the result of the first step was significant in a given subject). The method results were compared with the surgery resection zones. From the whole cohort (N=25), the numbers of patients with significant results were: 10 patients in lobe detection and 9 patients in EZ detection. From these subsets of patients with significant results, the impaired lobe was successfully detected with 100% accuracy; the EZ was successfully detected with 89% accuracy. The detection of the EZ using iDrArK was substantially more successful when compared with solo diffusional parameters (or their pairwise combinations). For a subgroup with significant results from step one (N=10), iDrArK without lobe restriction achieved 37.5% accuracy; lobe-restricted iDrArK achieved 100% accuracy. The study shows the plausibility of MK for detecting widespread WM changes and the benefit of combining different diffusional voxel-wise parameters.
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Affiliation(s)
- Michaela Bartoňová
- grid.10267.320000 0001 2194 0956Central European Institute of Technology (CEITEC), Multimodal and Functional Neuroimaging Research Group, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic ,grid.10267.320000 0001 2194 0956Brno Epilepsy Center, Full member of the European Reference Network (ERN) EpiCARE, First Department of Neurology, St. Anne′s University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marek Bartoň
- grid.10267.320000 0001 2194 0956Central European Institute of Technology (CEITEC), Multimodal and Functional Neuroimaging Research Group, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Pavel Říha
- grid.10267.320000 0001 2194 0956Central European Institute of Technology (CEITEC), Multimodal and Functional Neuroimaging Research Group, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic ,grid.10267.320000 0001 2194 0956Brno Epilepsy Center, Full member of the European Reference Network (ERN) EpiCARE, First Department of Neurology, St. Anne′s University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lubomír Vojtíšek
- grid.10267.320000 0001 2194 0956Central European Institute of Technology (CEITEC), Multimodal and Functional Neuroimaging Research Group, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Milan Brázdil
- grid.10267.320000 0001 2194 0956Central European Institute of Technology (CEITEC), Multimodal and Functional Neuroimaging Research Group, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic ,grid.10267.320000 0001 2194 0956Brno Epilepsy Center, Full member of the European Reference Network (ERN) EpiCARE, First Department of Neurology, St. Anne′s University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ivan Rektor
- grid.10267.320000 0001 2194 0956Central European Institute of Technology (CEITEC), Multimodal and Functional Neuroimaging Research Group, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic ,grid.10267.320000 0001 2194 0956Brno Epilepsy Center, Full member of the European Reference Network (ERN) EpiCARE, First Department of Neurology, St. Anne′s University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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13
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Gyori NG, Clark CA, Alexander DC, Kaden E. On the potential for mapping apparent neural soma density via a clinically viable diffusion MRI protocol. Neuroimage 2021; 239:118303. [PMID: 34174390 PMCID: PMC8363942 DOI: 10.1016/j.neuroimage.2021.118303] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 12/14/2022] Open
Abstract
B-tensor encoding enables estimation of spherical cellular structures in the brain. Spherical compartments may provide markers for apparent neural soma density. Model parameters can be estimated in a fast and robust way using deep learning. Practical acquisition times are achievable on widely available clinical scanners.
Diffusion MRI is a valuable tool for probing tissue microstructure in the brain noninvasively. Today, model-based techniques are widely available and used for white matter characterisation where their development is relatively mature. Conversely, tissue modelling in grey matter is more challenging, and no generally accepted models exist. With advances in measurement technology and modelling efforts, a clinically viable technique that reveals salient features of grey matter microstructure, such as the density of quasi-spherical cell bodies and quasi-cylindrical cell projections, is an exciting prospect. As a step towards capturing the microscopic architecture of grey matter in clinically feasible settings, this work uses a biophysical model that is designed to disentangle the diffusion signatures of spherical and cylindrical structures in the presence of orientation heterogeneity, and takes advantage of B-tensor encoding measurements, which provide additional sensitivity compared to standard single diffusion encoding sequences. For the fast and robust estimation of microstructural parameters, we leverage recent advances in machine learning and replace conventional fitting techniques with an artificial neural network that fits complex biophysical models within seconds. Our results demonstrate apparent markers of spherical and cylindrical geometries in healthy human subjects, and in particular an increased volume fraction of spherical compartments in grey matter compared to white matter. We evaluate the extent to which spherical and cylindrical geometries may be interpreted as correlates of neural soma and neural projections, respectively, and quantify parameter estimation errors in the presence of various departures from the modelling assumptions. While further work is necessary to translate the ideas presented in this work to the clinic, we suggest that biomarkers focussing on quasi-spherical cellular geometries may be valuable for the enhanced assessment of neurodevelopmental disorders and neurodegenerative diseases.
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Affiliation(s)
- Noemi G Gyori
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom; Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
| | - Christopher A Clark
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Enrico Kaden
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom; Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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14
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Lorio S, Sedlacik J, So PW, Parkes HG, Gunny R, Löbel U, Li YF, Ogunbiyi O, Mistry T, Dixon E, Adler S, Cross JH, Baldeweg T, Jacques TS, Shmueli K, Carmichael DW. Quantitative MRI susceptibility mapping reveals cortical signatures of changes in iron, calcium and zinc in malformations of cortical development in children with drug-resistant epilepsy. Neuroimage 2021; 238:118102. [PMID: 34058334 PMCID: PMC8350142 DOI: 10.1016/j.neuroimage.2021.118102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Malformations of cortical development (MCD), including focal cortical dysplasia (FCD), are the most common cause of drug-resistant focal epilepsy in children. Histopathological lesion characterisation demonstrates abnormal cell types and lamination, alterations in myelin (typically co-localised with iron), and sometimes calcification. Quantitative susceptibility mapping (QSM) is an emerging MRI technique that measures tissue magnetic susceptibility (χ) reflecting it's mineral composition. We used QSM to investigate abnormal tissue composition in a group of children with focal epilepsy with comparison to effective transverse relaxation rate (R2*) and Synchrotron radiation X-ray fluorescence (SRXRF) elemental maps. Our primary hypothesis was that reductions in χ would be found in FCD lesions, resulting from alterations in their iron and calcium content. We also evaluated deep grey matter nuclei for changes in χ with age. METHODS QSM and R2* maps were calculated for 40 paediatric patients with suspected MCD (18 histologically confirmed) and 17 age-matched controls. Patients' sub-groups were defined based on concordant electro-clinical or histopathology data. Quantitative investigation of QSM and R2* was performed within lesions, using a surface-based approach with comparison to homologous regions, and within deep brain regions using a voxel-based approach with regional values modelled with age and epilepsy as covariates. Synchrotron radiation X-ray fluorescence (SRXRF) was performed on brain tissue resected from 4 patients to map changes in iron, calcium and zinc and relate them to MRI parameters. RESULTS Compared to fluid-attenuated inversion recovery (FLAIR) or T1-weighted imaging, QSM improved lesion conspicuity in 5% of patients. In patients with well-localised lesions, quantitative profiling demonstrated decreased χ, but not R2*, across cortical depth with respect to the homologous regions. Contra-lateral homologous regions additionally exhibited increased χ at 2-3 mm cortical depth that was absent in lesions. The iron decrease measured by the SRXRF in FCDIIb lesions was in agreement with myelin reduction observed by Luxol Fast Blue histochemical staining. SRXRF analysis in two FCDIIb tissue samples showed increased zinc and calcium in one patient, and decreased iron in the brain region exhibiting low χ and high R2* in both patients. QSM revealed expected age-related changes in the striatum nuclei, substantia nigra, sub-thalamic and red nucleus. CONCLUSION QSM non-invasively revealed cortical/sub-cortical tissue alterations in MCD lesions and in particular that χ changes in FCDIIb lesions were consistent with reduced iron, co-localised with low myelin and increased calcium and zinc content. These findings suggest that measurements of cortical χ could be used to characterise tissue properties non-invasively in epilepsy lesions.
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Affiliation(s)
- Sara Lorio
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK; Wellcome EPSRC Centre for Medical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK
| | - Jan Sedlacik
- Biomedical Engineering Department, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Center for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Po-Wah So
- Department of Neuroimaging, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Harold G Parkes
- Department of Neuroimaging, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Roxana Gunny
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ulrike Löbel
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Yao-Feng Li
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London and Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Pathology Department, Tri-Service General Hospital and National Defence Medical Centre, Taipei, Taiwan, ROC
| | - Olumide Ogunbiyi
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London and Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Talisa Mistry
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London and Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Emma Dixon
- MRI Group, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Sophie Adler
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - J Helen Cross
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Torsten Baldeweg
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Thomas S Jacques
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London and Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Karin Shmueli
- MRI Group, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - David W Carmichael
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK; Wellcome EPSRC Centre for Medical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, UK.
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15
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Specchio N, Pepi C, De Palma L, Trivisano M, Vigevano F, Curatolo P. Neuroimaging and genetic characteristics of malformation of cortical development due to mTOR pathway dysregulation: clues for the epileptogenic lesions and indications for epilepsy surgery. Expert Rev Neurother 2021; 21:1333-1345. [PMID: 33754929 DOI: 10.1080/14737175.2021.1906651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Malformation of cortical development (MCD) is strongly associated with drug-resistant epilepsies for which surgery to remove epileptogenic lesions is common. Two notable technological advances in this field are identification of the underlying genetic cause and techniques in neuroimaging. These now question how presurgical evaluation ought to be approached for 'mTORpathies.'Area covered: From review of published primary and secondary articles, the authors summarize evidence to consider focal cortical dysplasia (FCD), tuber sclerosis complex (TSC), and hemimegalencephaly (HME) collectively as MCD mTORpathies. The authors also consider the unique features of these related conditions with particular focus on the practicalities of using neuroimaging techniques currently available to define surgical targets and predict post-surgical outcome. Ultimately, the authors consider the surgical dilemmas faced for each condition.Expert opinion: Considering FCD, TSC, and HME collectively as mTORpathies has some merit; however, a unified approach to presurgical evaluation would seem unachievable. Nevertheless, the authors believe combining genetic-centered classification and morphologic findings using advanced imaging techniques will eventually form the basis of a paradigm when considering candidacy for early surgery.
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Affiliation(s)
- Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
| | - Chiara Pepi
- Rare and Complex Epilepsy Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
| | - Luca De Palma
- Rare and Complex Epilepsy Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
| | - Marina Trivisano
- Rare and Complex Epilepsy Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
| | - Federico Vigevano
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, Rome, Italy
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16
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Snyder K, Whitehead EP, Theodore WH, Zaghloul KA, Inati SJ, Inati SK. Distinguishing type II focal cortical dysplasias from normal cortex: A novel normative modeling approach. NEUROIMAGE-CLINICAL 2021; 30:102565. [PMID: 33556791 PMCID: PMC7887437 DOI: 10.1016/j.nicl.2021.102565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/21/2020] [Accepted: 01/11/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Focal cortical dysplasias (FCDs) are a common cause of apparently non-lesional drug-resistant focal epilepsy. Visual detection of subtle FCDs on MRI is clinically important and often challenging. In this study, we implement a set of 3D local image filters adapted from computer vision applications to characterize the appearance of normal cortex surrounding the gray-white junction. We create a normative model to serve as the basis for a novel multivariate constrained outlier approach to automated FCD detection. METHODS Standardized MPRAGE, T2 and FLAIR MR images were obtained in 15 patients with radiologically or histologically diagnosed FCDs and 30 healthy volunteers. Multiscale 3D local image filters were computed for each MR contrast then sampled onto the gray-white junction surface. Using an iterative Gaussianization procedure, we created a normative model of cortical variability in healthy volunteers, allowing for identification of outlier regions and estimates of similarity in normal cortex and FCD lesions. We used a constrained outlier approach following local normalization to automatically detect FCD lesions based on projection onto the mean FCD feature vector. RESULTS FCDs as well as some normal cortical regions such as primary sensorimotor and paralimbic regions appear as outliers. Regions such as the paralimbic regions and the anterior insula have similar features to FCDs. Our constrained outlier approach allows for automated FCD detection with 80% sensitivity and 70% specificity. SIGNIFICANCE A normative model using multiscale local image filters can be used to describe the normal cortical variability. Although FCDs appear similar to some cortical regions such as the anterior insula and paralimbic cortices, they can be identified using a constrained outlier detection approach. Our method for detecting outliers and estimating similarity is generic and could be extended to identification of other types of lesions or atypical cortical areas.
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Affiliation(s)
- Kathryn Snyder
- EEG Section, Office of the Clinical Director, NINDS, National Institutes of Health, United States
| | | | - William H Theodore
- Clinical Epilepsy Section, NINDS, National Institutes of Health, United States
| | - Kareem A Zaghloul
- Surgical Neurology Branch, NINDS, National Institutes of Health, United States
| | - Souheil J Inati
- Office of the Clinical Director, NINDS, National Institutes of Health, United States
| | - Sara K Inati
- EEG Section, Office of the Clinical Director, NINDS, National Institutes of Health, United States.
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Chen SD, Pan HY, Huang JB, Liu XP, Li JH, Ho CJ, Tsai MH, Yang JL, Chen SF, Chen NC, Chuang YC. Circulating MicroRNAs from Serum Exosomes May Serve as a Putative Biomarker in the Diagnosis and Treatment of Patients with Focal Cortical Dysplasia. Cells 2020; 9:cells9081867. [PMID: 32785072 PMCID: PMC7465068 DOI: 10.3390/cells9081867] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/03/2020] [Accepted: 08/08/2020] [Indexed: 12/12/2022] Open
Abstract
Focal cortical dysplasia (FCD) is a congenital malformation of cortical development where the cortical neurons located in the brain area fail to migrate in the proper formation. Epilepsy, particularly medically refractory epilepsy, is the most common clinical presentation for all types of FCD. This study aimed to explore the expression change of circulating miRNAs in patients with FCD from serum exosomes. A total of nine patients with FCD and four healthy volunteers were enrolled in this study. The serum exosomes were isolated from the peripheral blood of the subjects. Transmission electron microscopy (TEM) was used to identify the exosomes. Both exosomal markers and neuronal markers were detected by Western blotting analysis to prove that we could obtain central nervous system-derived exosomes from the circulation. The expression profiles of circulating exosomal miRNAs were assessed using next-generation sequencing analysis (NGS). We obtained a total of 107 miRNAs with dominant fold change (>2-fold) from both the annotated 5p-arm and 3p-arm of 2780 mature miRNAs. Based on the integrated platform of HMDD v3.2, miRway DB and DIANA-miRPath v3.0 online tools, and confirmed by MiRBase analysis, four potentially predicted miRNAs from serum exosomes in patients with FCD were identified, including miR194-2-5p, miR15a-5p, miR-132-3p, and miR-145-5p. All four miRNAs presented upregulated expression in patients with FCD compared with controls. Through Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis and pathway category of four target miRNAs, we found eight possible signaling pathways that may be related to FCD. Among them, we suggest that the mTOR signaling pathway, PI3K-Akt signaling pathway, p53 signaling pathway, and cell cycle regulation and TGF-beta signaling pathway are high-risk pathways that play a crucial role in the pathogenesis of FCD and refractory epilepsy. Our results suggest that the circulating miRNAs from exosomes may provide a potential biomarker for diagnostic, prognostic, and therapeutic adjuncts in patients with FCD and refractory epilepsy.
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Affiliation(s)
- Shang-Der Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (S.-D.C.); (C.-J.H.); (M.-H.T.); (S.-F.C.); (N.-C.C.)
- Institute for Translation Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (X.-P.L.); (J.-H.L.); (J.-L.Y.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Hsiu-Yung Pan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (H.-Y.P.); (J.-B.H.)
| | - Jyun-Bin Huang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (H.-Y.P.); (J.-B.H.)
| | - Xuan-Ping Liu
- Institute for Translation Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (X.-P.L.); (J.-H.L.); (J.-L.Y.)
| | - Jie-Hau Li
- Institute for Translation Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (X.-P.L.); (J.-H.L.); (J.-L.Y.)
| | - Chen-Jui Ho
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (S.-D.C.); (C.-J.H.); (M.-H.T.); (S.-F.C.); (N.-C.C.)
| | - Meng-Han Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (S.-D.C.); (C.-J.H.); (M.-H.T.); (S.-F.C.); (N.-C.C.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Jenq-Lin Yang
- Institute for Translation Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (X.-P.L.); (J.-H.L.); (J.-L.Y.)
| | - Shu-Fang Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (S.-D.C.); (C.-J.H.); (M.-H.T.); (S.-F.C.); (N.-C.C.)
| | - Nai-Ching Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (S.-D.C.); (C.-J.H.); (M.-H.T.); (S.-F.C.); (N.-C.C.)
| | - Yao-Chung Chuang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (S.-D.C.); (C.-J.H.); (M.-H.T.); (S.-F.C.); (N.-C.C.)
- Institute for Translation Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan; (X.-P.L.); (J.-H.L.); (J.-L.Y.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Biological Science, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
- Correspondence:
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18
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Jackson HN, Gadgil N, Pan IW, Clarke DF, Wagner KM, Cronkite CA, Lam S. Sociodemographic Factors in Pediatric Epilepsy Surgery. Pediatr Neurol 2020; 107:71-76. [PMID: 32284204 DOI: 10.1016/j.pediatrneurol.2019.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/24/2019] [Accepted: 09/02/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite documented efficacy of surgical treatment in carefully selected patients, surgery is delayed and/or underutilized in both adult and children with focal onset epilepsy. The reasons for surgical delay are often assumed or theorized, and studies have predominantly targeted the adult population. To focus on a more targeted pediatric population and to determine identifiable reasons for intervention, this study aimed to investigate time to epilepsy surgery among pediatric patients with medically intractable epilepsy associated with focal cortical dysplasia and to identify sociodemographic and clinical associations in time to epilepsy surgery. METHODS We reviewed 96 consecutive pediatric patients who underwent surgery for medically intractable epilepsy with a diagnosis of focal cortical dysplasia. Descriptive statistics, univariate and multivariate analyses were conducted to study the association of sociodemographic variables of patients with focal cortical dysplasia and time to epilepsy surgery and postoperative seizure control. RESULTS We identified that non-white patients on average had a longer duration of epilepsy before surgery and traveled shorter distances for care. Non-white patients were more likely to have government-funded insurance. Patients who traveled the shortest distance to the surgical center underwent epilepsy surgery at an older age. CONCLUSIONS Sociodemographic factors of travel distance, insurance, and race influenced time to epilepsy surgery for children with focal cortical dysplasia. Further research is warranted to target barriers in access to subspecialty care and develop ways to identify earlier the patients who may benefit from evaluation and deployment of surgical intervention.
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Affiliation(s)
- Hudin N Jackson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Nisha Gadgil
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - I-Wen Pan
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, MD Anderson Cancer Center, Houston, Texas
| | - Dave F Clarke
- Division of Pediatric Neurology, Department of Neurology, Dell Medical School University of Texas at Austin, Austin, Texas
| | - Kathryn M Wagner
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Sandi Lam
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital, Chicago, Illinois; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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19
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Lorio S, Adler S, Gunny R, D'Arco F, Kaden E, Wagstyl K, Jacques TS, Clark CA, Cross JH, Baldeweg T, Carmichael DW. MRI profiling of focal cortical dysplasia using multi-compartment diffusion models. Epilepsia 2020; 61:433-444. [PMID: 32065673 PMCID: PMC7154549 DOI: 10.1111/epi.16451] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 12/11/2022]
Abstract
Objective Focal cortical dysplasia (FCD) lesion detection and subtyping remain challenging on conventional MRI. New diffusion models such as the spherical mean technique (SMT) and neurite orientation dispersion and density imaging (NODDI) provide measurements that potentially produce more specific maps of abnormal tissue microstructure. This study aims to assess the SMT and NODDI maps for computational and radiological lesion characterization compared to standard fractional anisotropy (FA) and mean diffusivity (MD). Methods SMT, NODDI, FA, and MD maps were calculated for 33 pediatric patients with suspected FCD (18 histologically confirmed). Two neuroradiologists scored lesion visibility on clinical images and diffusion maps. Signal profile changes within lesions and homologous regions were quantified using a surface‐based approach. Diffusion parameter changes at multiple cortical depths were statistically compared between FCD type IIa and type IIb. Results Compared to fluid‐attenuated inversion recovery (FLAIR) or T1‐weighted imaging, lesions conspicuity on NODDI intracellular volume fraction (ICVF) maps was better/equal/worse in 5/14/14 patients, respectively, while on SMT intra‐neurite volume fraction (INVF) in 3/3/27. Compared to FA or MD, lesion conspicuity on the ICVF was better/equal/worse in 27/4/2, while on the INVF in 20/7/6. Quantitative signal profiling demonstrated significant ICVF and INVF reductions in the lesions, whereas SMT microscopic mean, radial, and axial diffusivities were significantly increased. FCD type IIb exhibited greater changes than FCD type IIa. No changes were detected on FA or MD profiles. Significance FCD lesion‐specific signal changes were found in ICVF and INVF but not in FA and MD maps. ICVF and INVF showed greater contrast than FLAIR in some cases and had consistent signal changes specific to FCD, suggesting that they could improve current presurgical pediatric epilepsy imaging protocols and can provide features useful for automated lesion detection.
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Affiliation(s)
- Sara Lorio
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK.,School of Biomedical Engineering & Imaging Sciences, St Thomas' Hospital, King's College London, London, UK
| | - Sophie Adler
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | | | - Enrico Kaden
- Centre for Medical Image Computing, University College London, London, UK
| | - Konrad Wagstyl
- Brain Mapping Unit, Institute of Psychiatry, University of Cambridge, Cambridge, UK
| | - Thomas S Jacques
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Chris A Clark
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Judith Helen Cross
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Torsten Baldeweg
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - David W Carmichael
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK.,School of Biomedical Engineering & Imaging Sciences, St Thomas' Hospital, King's College London, London, UK
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20
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Bartolini E, Cosottini M, Costagli M, Barba C, Tassi L, Spreafico R, Garbelli R, Biagi L, Buccoliero A, Giordano F, Guerrini R. Ultra-High-Field Targeted Imaging of Focal Cortical Dysplasia: The Intracortical Black Line Sign in Type IIb. AJNR Am J Neuroradiol 2019; 40:2137-2142. [PMID: 31727747 DOI: 10.3174/ajnr.a6298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Conventional MR imaging has limitations in detecting focal cortical dysplasia. We assessed the added value of 7T in patients with histologically proved focal cortical dysplasia to highlight correlations between neuropathology and ultra-high-field imaging. MATERIALS AND METHODS Between 2013 and 2019, we performed a standardized 7T MR imaging protocol in patients with drug-resistant focal epilepsy. We focused on 12 patients in whom postsurgical histopathology revealed focal cortical dysplasia and explored the diagnostic yield of preoperative 7T versus 1.5/3T MR imaging and the correlations of imaging findings with histopathology. We also assessed the relationship between epilepsy surgery outcome and the completeness of surgical removal of the MR imaging-visible structural abnormality. RESULTS We observed clear abnormalities in 10/12 patients using 7T versus 9/12 revealed by 1.5/3T MR imaging. In patients with focal cortical dysplasia I, 7T MR imaging did not disclose morphologic abnormalities (n = 0/2). In patients with focal cortical dysplasia II, 7T uncovered morphologic signs that were not visible on clinical imaging in 1 patient with focal cortical dysplasia IIa (n = 1/4) and in all those with focal cortical dysplasia IIb (n = 6/6). T2*WI provided the highest added value, disclosing a peculiar intracortical hypointense band (black line) in 5/6 patients with focal cortical dysplasia IIb. The complete removal of the black line was associated with good postsurgical outcome (n = 4/5), while its incomplete removal yielded unsatisfactory results (n = 1/5). CONCLUSIONS The high sensitivity of 7T T2*-weighted images provides an additional tool in defining potential morphologic markers of high epileptogenicity within the dysplastic tissue of focal cortical dysplasia IIb and will likely help to more precisely plan epilepsy surgery and explain surgical failures.
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Affiliation(s)
- E Bartolini
- From the Department of Pediatric Neurology (E.B., C.B., A.B., R. Guerrini).,Neurology Unit (E.B.), USL Centro Toscana, Nuovo Ospedale Santo Stefano, Prato, Italy
| | - M Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery (M. Cosottini), University of Pisa, Pisa, Italy
| | - M Costagli
- IMAGO7 Research Foundation (M. Costagli), Pisa, Italy
| | - C Barba
- From the Department of Pediatric Neurology (E.B., C.B., A.B., R. Guerrini)
| | - L Tassi
- Epilepsy Surgery Centre C. Munari (L.T.), Ospedale Niguarda, Milano, Italy
| | - R Spreafico
- Clinical Epileptology and Experimental Neurophysiology Unit (R.S., R. Garbelli), Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico C. Besta, Milano, Italy
| | - R Garbelli
- Clinical Epileptology and Experimental Neurophysiology Unit (R.S., R. Garbelli), Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico C. Besta, Milano, Italy
| | - L Biagi
- Istituto Di Ricovero e Cura a Carattere Scientifico Fondazione Stella Maris (L.B., R. Guerrini), Pisa, Italy
| | - A Buccoliero
- From the Department of Pediatric Neurology (E.B., C.B., A.B., R. Guerrini)
| | - F Giordano
- Neurogenetics and Neurobiology Unit and Laboratories, and Pediatric Neurosurgery Unit (F.G.), Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - R Guerrini
- From the Department of Pediatric Neurology (E.B., C.B., A.B., R. Guerrini) .,Istituto Di Ricovero e Cura a Carattere Scientifico Fondazione Stella Maris (L.B., R. Guerrini), Pisa, Italy
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21
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Gyebnár G, Klimaj Z, Entz L, Fabó D, Rudas G, Barsi P, Kozák LR. Personalized microstructural evaluation using a Mahalanobis-distance based outlier detection strategy on epilepsy patients' DTI data - Theory, simulations and example cases. PLoS One 2019; 14:e0222720. [PMID: 31545838 PMCID: PMC6756533 DOI: 10.1371/journal.pone.0222720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/05/2019] [Indexed: 11/19/2022] Open
Abstract
Quantitative MRI methods have recently gained extensive interest and are seeing substantial developments; however, their application in single patient vs control group comparisons is often limited by inherent statistical difficulties. One such application is detecting malformations of cortical development (MCDs) behind drug resistant epilepsies, a task that, especially when based solely on conventional MR images, may represent a serious challenge. We aimed to develop a novel straightforward voxel-wise evaluation method based on the Mahalanobis-distance, combining quantitative MRI data into a multidimensional parameter space and detecting lesion voxels as outliers. Simulations with standard multivariate Gaussian distribution and resampled DTI-eigenvalue data of 45 healthy control subjects determined the optimal critical value, cluster size threshold, and the expectable lesion detection performance through ROC-analyses. To reduce the effect of false positives emanating from registration artefacts and gyrification differences, an automatic classification method was applied, fine-tuned using a leave-one-out strategy based on diffusion and T1-weighted data of the controls. DWI processing, including thorough corrections and robust tensor fitting was performed with ExploreDTI, spatial coregistration was achieved with the DARTEL tools of SPM12. Additional to simulations, clusters of outlying diffusion profile, concordant with neuroradiological evaluation and independent calculations with the MAP07 toolbox were identified in 12 cases of a 13 patient example population with various types of MCDs. The multidimensional approach proved sufficiently sensitive in pinpointing regions of abnormal tissue microstructure using DTI data both in simulations and in the heterogeneous example population. Inherent limitations posed by registration artefacts, age-related differences, and the different or mixed pathologies limit the generalization of specificity estimation. Nevertheless, the proposed statistical method may aid the everyday examination of individual subjects, ever so more upon extending the framework with quantitative information from other modalities, e.g. susceptibility mapping, relaxometry, or perfusion.
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Affiliation(s)
- Gyula Gyebnár
- Magnetic Resonance Research Centre, Semmelweis University, Budapest, Hungary
- * E-mail:
| | - Zoltán Klimaj
- Magnetic Resonance Research Centre, Semmelweis University, Budapest, Hungary
| | - László Entz
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Gábor Rudas
- Magnetic Resonance Research Centre, Semmelweis University, Budapest, Hungary
| | - Péter Barsi
- Magnetic Resonance Research Centre, Semmelweis University, Budapest, Hungary
| | - Lajos R. Kozák
- Magnetic Resonance Research Centre, Semmelweis University, Budapest, Hungary
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22
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7T GRE-MRI signal compartments are sensitive to dysplastic tissue in focal epilepsy. Magn Reson Imaging 2019; 61:1-8. [DOI: 10.1016/j.mri.2019.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 04/19/2019] [Accepted: 05/04/2019] [Indexed: 12/11/2022]
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Benova B, Jacques TS. Genotype-phenotype correlations in focal malformations of cortical development: a pathway to integrated pathological diagnosis in epilepsy surgery. Brain Pathol 2019; 29:473-484. [PMID: 30485578 PMCID: PMC8028510 DOI: 10.1111/bpa.12686] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/20/2018] [Indexed: 12/18/2022] Open
Abstract
Malformations of cortical development (MCD) comprise a broad spectrum of developmental brain abnormalities. Patients presenting with MCDs often suffer from drug-resistant focal epilepsy, and some become candidates for epilepsy surgery. Their likelihood of achieving freedom from seizures, however, remains uncertain, and depends in a major part on the underlying pathology. Tissue samples obtained in epilepsy surgery form the basis of definite histopathological diagnosis; however, new molecular genetic methods have not yet been implemented in diagnostic processes for MCD cases. Furthermore, it has not been completely understood how the underlying pathology affects patients' outcomes after epilepsy surgery. We performed a systematic literature review of studies describing both histopathological and molecular genetic findings in MCD, along with studies on epilepsy surgery outcomes. We aimed to correlate the genetic causes with the underlying morphological abnormalities in focal cortical malformations and to stress the importance of the underlying biology for patient management and counseling. From the summarized findings of multiple authors, it is obvious that MCD may have a diverse genetic background despite a similar or even identical histopathological picture. Even though most of their molecular genetic findings converge on various levels of the PI3K/AKT/mTOR pathway, the exact mechanisms underlying MCD formation have not yet been completely described or indeed how this pathway generates a diverse range of histological abnormalities. Based on our findings, we therefore propose that all patients diagnosed and operated for drug-resistant epilepsy should have an integrated molecular and pathological diagnosis similar to the current practice in brain tumor diagnostic processes that might lead to more accurate diagnosis and effective stratification of patients undergoing epilepsy surgery.
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Affiliation(s)
- Barbora Benova
- 2nd Faculty of Medicine, Department of Paediatric NeurologyCharles University and Motol University HospitalPragueCzech Republic
- 2nd Faculty of MedicineCharles UniversityPragueCzech Republic
- Developmental Biology and Cancer ProgrammeUCL GOS Institute of Child HealthLondonUK
| | - Thomas S. Jacques
- Developmental Biology and Cancer ProgrammeUCL GOS Institute of Child HealthLondonUK
- Department of HistopathologyGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
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24
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Kimura Y, Shioya A, Saito Y, Oitani Y, Shigemoto Y, Morimoto E, Suzuki F, Ikegaya N, Kimura Y, Iijima K, Takayama Y, Iwasaki M, Sasaki M, Sato N. Radiologic and Pathologic Features of the Transmantle Sign in Focal Cortical Dysplasia: The T1 Signal Is Useful for Differentiating Subtypes. AJNR Am J Neuroradiol 2019; 40:1060-1066. [PMID: 31097427 DOI: 10.3174/ajnr.a6067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 03/27/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The transmantle sign is a characteristic MR imaging finding often seen in focal cortical dysplasia type IIb. The transmantle sign is typically hyperintense on T2WI and FLAIR and hypointense on T1WI. However, in some cases, it shows T1 high signal. We evaluated the imaging and pathologic findings to identify the causes of the T1 high signal in the transmantle sign. MATERIALS AND METHODS We retrospectively reviewed the preoperative imaging data of 141 consecutive patients with histologically proved focal cortical dysplasia. We selected 25 patients with focal cortical dysplasia with the transmantle sign and divided them into groups based on the pathologic focal cortical dysplasia subtype and T1 signal of the transmantle sign. We evaluated the clinical, radiologic, and pathologic findings, including the number of balloon cells and dysmorphic neurons and the severity of gliosis or calcifications and compared them among the groups. RESULTS Nine of the 25 patients had a T1-high-signal transmantle sign; the other 16 patients did not. All 9 patients with a T1-high-signal transmantle sign were diagnosed as type IIb (group A). Of the 16 patients with no T1-high-signal transmantle sign, 13 were diagnosed as having type IIb (group B), and the other 3 patients, as type IIa (group C). The number of balloon cells was significantly higher in group A than in the other groups, but there were no differences regarding dysmorphic neurons, the severity of gliosis, or calcifications. CONCLUSIONS Approximately 6% (9/141) of this patient series had a T1-high-signal transmantle sign, and all were type IIb. The signal may reflect a rich density of balloon cells. This finding could support the differentiation of subtypes, especially type IIb.
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Affiliation(s)
- Yukio Kimura
- From the Department of Radiology (Yukio K., Y. Shigemoto, E.M., F.S., N.S.), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - A Shioya
- Departments of Pathology and Laboratory Medicine (A.S., Y. Saito)
- Department of Neurology (A.S.), Mito Kyodo General Hospital, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Y Saito
- Departments of Pathology and Laboratory Medicine (A.S., Y. Saito)
| | - Y Oitani
- Child Neurology (Y.O., M.S.)
- Department of Pediatrics (Y.O.), Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Y Shigemoto
- From the Department of Radiology (Yukio K., Y. Shigemoto, E.M., F.S., N.S.), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - E Morimoto
- From the Department of Radiology (Yukio K., Y. Shigemoto, E.M., F.S., N.S.), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - F Suzuki
- From the Department of Radiology (Yukio K., Y. Shigemoto, E.M., F.S., N.S.), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - N Ikegaya
- Neurosurgery (N.I., Yuiko K., K.I., Y.T., M.I.), National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
- Department of Neurosurgery (N.I.), Yokohama City University, Yokohama, Kangawa, Japan
| | - Yuiko Kimura
- Neurosurgery (N.I., Yuiko K., K.I., Y.T., M.I.), National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - K Iijima
- Neurosurgery (N.I., Yuiko K., K.I., Y.T., M.I.), National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Y Takayama
- Neurosurgery (N.I., Yuiko K., K.I., Y.T., M.I.), National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - M Iwasaki
- Neurosurgery (N.I., Yuiko K., K.I., Y.T., M.I.), National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | | | - N Sato
- From the Department of Radiology (Yukio K., Y. Shigemoto, E.M., F.S., N.S.), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
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25
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Guye M, Bartolomei F, Ranjeva JP. Malformations of cortical development: The role of 7-Tesla magnetic resonance imaging in diagnosis. Rev Neurol (Paris) 2019; 175:157-162. [DOI: 10.1016/j.neurol.2019.01.393] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/14/2018] [Accepted: 01/02/2019] [Indexed: 12/31/2022]
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26
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Abstract
Epilepsy in infants and children is one of the most common and devastating neurological disorders. In the past, we had a limited understanding of the causes of epilepsy in pediatric patients, so we treated pediatric epilepsy according to seizure type. Now with new tools and tests, we are entering the age of precision medicine in pediatric epilepsy. In this review, we use the new etiological classification system proposed by the International League Against Epilepsy to review the advances in the diagnosis of pediatric epilepsy, describe new tools to identify seizure foci for epilepsy surgery, and define treatable epilepsy syndromes.
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Affiliation(s)
- Priya Sharma
- Department of Neurology, University of North Carolina School of Medicine, Physicians Office Building, Chapel Hill, NC, 27599-7025, USA
| | - Ammar Hussain
- Department of Neurology, University of North Carolina School of Medicine, Physicians Office Building, Chapel Hill, NC, 27599-7025, USA
| | - Robert Greenwood
- Department of Neurology & Pediatrics, University of North Carolina School of Medicine, 2141 Physicians Office Building, Chapel Hill, NC, 27599-7025, USA
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27
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Adler S, Blackwood M, Northam GB, Gunny R, Hong SJ, Bernhardt BC, Bernasconi A, Bernasconi N, Jacques T, Tisdall M, Carmichael DW, Cross JH, Baldeweg T. Multimodal computational neocortical anatomy in pediatric hippocampal sclerosis. Ann Clin Transl Neurol 2018; 5:1200-1210. [PMID: 30349855 PMCID: PMC6186946 DOI: 10.1002/acn3.634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 12/16/2022] Open
Abstract
Objective In contrast to adult cohorts, neocortical changes in epileptic children with hippocampal damage are not well characterized. Here, we mapped multimodal neocortical markers of epilepsy‐related structural compromise in a pediatric cohort of temporal lobe epilepsy and explored how they relate to clinical factors. Methods We measured cortical thickness, gray–white matter intensity contrast and intracortical FLAIR intensity in 22 patients with hippocampal sclerosis (HS) and 30 controls. Surface‐based linear models assessed between‐group differences in morphological and MR signal intensity markers. Structural integrity of the hippocampus was measured by quantifying atrophy and FLAIR patterns. Linear models were used to evaluate the relationships between hippocampal and neocortical MRI markers and clinical factors. Results In the hippocampus, patients demonstrated ipsilateral atrophy and bilateral FLAIR hyperintensity. In the neocortex, patients showed FLAIR signal hyperintensities and gray–white matter boundary blurring in the ipsilesional mesial and lateral temporal neocortex. In contrast, cortical thinning was minimal and restricted to a small area of the ipsilesional temporal pole. Furthermore, patients with a history of febrile convulsions demonstrated more pronounced FLAIR hyperintensity in the ipsilesional temporal neocortex. Interpretation Pediatric HS patients do not yet demonstrate the widespread cortical thinning present in adult cohorts, which may reflect consequences of a protracted disease process. However, pronounced temporal neocortical FLAIR hyperintensity and blurring of the gray–white matter boundary are already detectable, suggesting that alterations in MR signal intensities may reflect a different underlying pathophysiology that is detectable earlier in the disease and more pervasive in patients with a history of febrile convulsions.
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Affiliation(s)
- Sophie Adler
- Developmental Neurosciences UCL Great Ormond Street Institute of Child Health University College London London United Kingdom.,Great Ormond Street Hospital for Children London United Kingdom
| | - Mallory Blackwood
- Institute of Neurology University College London London United Kingdom
| | - Gemma B Northam
- Developmental Neurosciences UCL Great Ormond Street Institute of Child Health University College London London United Kingdom
| | - Roxana Gunny
- Great Ormond Street Hospital for Children London United Kingdom
| | - Seok-Jun Hong
- Neuroimaging of Epilepsy Laboratory McConnell Brain Imaging Centre Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
| | - Boris C Bernhardt
- Multimodal Imaging and Connectome Analysis Lab McConnell Brain Imaging Centre Montreal Neurological Institute McGill University Montreal Quebec Canada
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory McConnell Brain Imaging Centre Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory McConnell Brain Imaging Centre Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
| | - Thomas Jacques
- Developmental Biology and Cancer Programme UCL Great Ormond Street Institute of Child Health University College London London United Kingdom.,Department of Histopathology Great Ormond Street Hospital for Children NHS Foundation Trust London United Kingdom
| | - Martin Tisdall
- Developmental Neurosciences UCL Great Ormond Street Institute of Child Health University College London London United Kingdom.,Great Ormond Street Hospital for Children London United Kingdom
| | - David W Carmichael
- Developmental Neurosciences UCL Great Ormond Street Institute of Child Health University College London London United Kingdom.,Great Ormond Street Hospital for Children London United Kingdom
| | - J Helen Cross
- Developmental Neurosciences UCL Great Ormond Street Institute of Child Health University College London London United Kingdom.,Great Ormond Street Hospital for Children London United Kingdom
| | - Torsten Baldeweg
- Developmental Neurosciences UCL Great Ormond Street Institute of Child Health University College London London United Kingdom.,Great Ormond Street Hospital for Children London United Kingdom
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28
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Epitashvili N, San Antonio-Arce V, Brandt A, Schulze-Bonhage A. Scalp electroencephalographic biomarkers in epilepsy patients with focal cortical dysplasia. Ann Neurol 2018; 84:564-575. [DOI: 10.1002/ana.25322] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Nino Epitashvili
- Epilepsy Center; University Medical Center; Freiburg Germany
- MediClub Georgia; Tbilisi Georgia
| | - Victoria San Antonio-Arce
- Epilepsy Center; University Medical Center; Freiburg Germany
- Hospital Sant Joan de Déu; Barcelona Spain
| | - Armin Brandt
- Epilepsy Center; University Medical Center; Freiburg Germany
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29
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Jin B, Krishnan B, Adler S, Wagstyl K, Hu W, Jones S, Najm I, Alexopoulos A, Zhang K, Zhang J, Ding M, Wang S, Wang ZI. Automated detection of focal cortical dysplasia type II with surface-based magnetic resonance imaging postprocessing and machine learning. Epilepsia 2018; 59:982-992. [PMID: 29637549 DOI: 10.1111/epi.14064] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Focal cortical dysplasia (FCD) is a major pathology in patients undergoing surgical resection to treat pharmacoresistant epilepsy. Magnetic resonance imaging (MRI) postprocessing methods may provide essential help for detection of FCD. In this study, we utilized surface-based MRI morphometry and machine learning for automated lesion detection in a mixed cohort of patients with FCD type II from 3 different epilepsy centers. METHODS Sixty-one patients with pharmacoresistant epilepsy and histologically proven FCD type II were included in the study. The patients had been evaluated at 3 different epilepsy centers using 3 different MRI scanners. T1-volumetric sequence was used for postprocessing. A normal database was constructed with 120 healthy controls. We also included 35 healthy test controls and 15 disease test controls with histologically confirmed hippocampal sclerosis to assess specificity. Features were calculated and incorporated into a nonlinear neural network classifier, which was trained to identify lesional cluster. We optimized the threshold of the output probability map from the classifier by performing receiver operating characteristic (ROC) analyses. Success of detection was defined by overlap between the final cluster and the manual labeling. Performance was evaluated using k-fold cross-validation. RESULTS The threshold of 0.9 showed optimal sensitivity of 73.7% and specificity of 90.0%. The area under the curve for the ROC analysis was 0.75, which suggests a discriminative classifier. Sensitivity and specificity were not significantly different for patients from different centers, suggesting robustness of performance. Correct detection rate was significantly lower in patients with initially normal MRI than patients with unequivocally positive MRI. Subgroup analysis showed the size of the training group and normal control database impacted classifier performance. SIGNIFICANCE Automated surface-based MRI morphometry equipped with machine learning showed robust performance across cohorts from different centers and scanners. The proposed method may be a valuable tool to improve FCD detection in presurgical evaluation for patients with pharmacoresistant epilepsy.
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Affiliation(s)
- Bo Jin
- Department of Neurology, School of Medicine, Epilepsy Center, Second Affiliated Hospital, Zhejiang University, Hangzhou, China.,Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Balu Krishnan
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Sophie Adler
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.,Great Ormond Street Hospital for Children, London, UK
| | - Konrad Wagstyl
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.,Brain Mapping Unit, Institute of Psychiatry, University of Cambridge, Cambridge, UK
| | - Wenhan Hu
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Stephen Jones
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Imad Najm
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | | | - Kai Zhang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Meiping Ding
- Department of Neurology, School of Medicine, Epilepsy Center, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Shuang Wang
- Department of Neurology, School of Medicine, Epilepsy Center, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
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