Optimizing Surgical Planning for Epilepsy Patients With Multimodal Neuroimaging and Neurophysiology Integration: A Case Study
Current preoperative evaluation of epilepsy can be challenging because of the lack of a comprehensive view of the network's dysfunctions. To demonstrate the utility of our multimodal neurophysiology and neuroimaging integration approach in the presurgical evaluation, we present a proof-of-conce...
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Published in | Journal of clinical neurophysiology Vol. 41; no. 4; p. 317 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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United States
01.05.2024
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Abstract | Current preoperative evaluation of epilepsy can be challenging because of the lack of a comprehensive view of the network's dysfunctions. To demonstrate the utility of our multimodal neurophysiology and neuroimaging integration approach in the presurgical evaluation, we present a proof-of-concept for using this approach in a patient with nonlesional frontal lobe epilepsy who underwent two resective surgeries to achieve seizure control. We conducted a post-hoc investigation using four neuroimaging and neurophysiology modalities: diffusion tensor imaging, resting-state functional MRI, and stereoelectroencephalography at rest and during seizures. We computed region-of-interest-based connectivity for each modality and applied betweenness centrality to identify key network hubs across modalities. Our results revealed that despite seizure semiology and stereoelectroencephalography indicating dysfunction in the right orbitofrontal region, the maximum overlap on the hubs across modalities extended to right temporal areas. Notably, the right middle temporal lobe region served as an overlap hub across diffusion tensor imaging, resting-state functional MRI, and rest stereoelectroencephalography networks and was only included in the resected area in the second surgery, which led to long-term seizure control of this patient. Our findings demonstrated that transmodal hubs could help identify key areas related to epileptogenic network. Therefore, this case presents a promising perspective of using a multimodal approach to improve the presurgical evaluation of patients with epilepsy. |
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AbstractList | Current preoperative evaluation of epilepsy can be challenging because of the lack of a comprehensive view of the network's dysfunctions. To demonstrate the utility of our multimodal neurophysiology and neuroimaging integration approach in the presurgical evaluation, we present a proof-of-concept for using this approach in a patient with nonlesional frontal lobe epilepsy who underwent two resective surgeries to achieve seizure control. We conducted a post-hoc investigation using four neuroimaging and neurophysiology modalities: diffusion tensor imaging, resting-state functional MRI, and stereoelectroencephalography at rest and during seizures. We computed region-of-interest-based connectivity for each modality and applied betweenness centrality to identify key network hubs across modalities. Our results revealed that despite seizure semiology and stereoelectroencephalography indicating dysfunction in the right orbitofrontal region, the maximum overlap on the hubs across modalities extended to right temporal areas. Notably, the right middle temporal lobe region served as an overlap hub across diffusion tensor imaging, resting-state functional MRI, and rest stereoelectroencephalography networks and was only included in the resected area in the second surgery, which led to long-term seizure control of this patient. Our findings demonstrated that transmodal hubs could help identify key areas related to epileptogenic network. Therefore, this case presents a promising perspective of using a multimodal approach to improve the presurgical evaluation of patients with epilepsy. |
Author | Bickel, Stephan Kuzniecky, Ruben I Tostaeva, Gelana Lado, Fred A Metha, Ashesh D Bonilha, Leonardo F Gleichgerrcht, Ezequiel L Gong, Ruxue |
Author_xml | – sequence: 1 givenname: Ruxue surname: Gong fullname: Gong, Ruxue organization: Department of Neurology, School of Medicine, Emory University, Atlanta, Georgia, U.S.A – sequence: 2 givenname: Stephan surname: Bickel fullname: Bickel, Stephan organization: The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, U.S.A. ; and – sequence: 3 givenname: Gelana surname: Tostaeva fullname: Tostaeva, Gelana organization: The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, U.S.A. ; and – sequence: 4 givenname: Fred A surname: Lado fullname: Lado, Fred A organization: The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, U.S.A. ; and – sequence: 5 givenname: Ashesh D surname: Metha fullname: Metha, Ashesh D organization: The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, U.S.A. ; and – sequence: 6 givenname: Ruben I surname: Kuzniecky fullname: Kuzniecky, Ruben I organization: Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, U.S.A – sequence: 7 givenname: Leonardo F surname: Bonilha fullname: Bonilha, Leonardo F organization: School of Medicine Columbia, University of South Carolina, Columbia, South Carolina, U.S.A – sequence: 8 givenname: Ezequiel L orcidid: 0000-0002-4212-4146 surname: Gleichgerrcht fullname: Gleichgerrcht, Ezequiel L organization: Department of Neurology, School of Medicine, Emory University, Atlanta, Georgia, U.S.A |
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SubjectTerms | Adult Brain - diagnostic imaging Brain - physiopathology Brain - surgery Diffusion Tensor Imaging Electroencephalography - methods Epilepsy - diagnostic imaging Epilepsy - physiopathology Epilepsy - surgery Epilepsy, Frontal Lobe - diagnostic imaging Epilepsy, Frontal Lobe - physiopathology Epilepsy, Frontal Lobe - surgery Female Humans Magnetic Resonance Imaging - methods Male Multimodal Imaging Neuroimaging - methods |
Title | Optimizing Surgical Planning for Epilepsy Patients With Multimodal Neuroimaging and Neurophysiology Integration: A Case Study |
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