Network‐targeted approach and postoperative resting‐state functional magnetic resonance imaging are associated with seizure outcome

Objective Postoperative resting‐state functional magnetic resonance imaging (MRI) in children with intractable epilepsy has not been quantified in relation to seizure outcome. Therefore, its value as a biomarker for epileptogenic pathology is not well understood. Methods In a sample of children with...

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Bibliographic Details
Published in:Annals of neurology 2019-09, Vol.86 (3), p.344-356
Main Authors: Boerwinkle, Varina L., Cediel, Emilio G., Mirea, Lucia, Williams, Korwyn, Kerrigan, John F., Lam, Sandi, Raskin, Jeffrey S., Desai, Virendra R., Wilfong, Angus A., Adelson, P. David, Curry, Daniel J.
Format: Article
Language:English
Subjects:
Biomarkers
Brain - physiopathology
Child
Children
Convulsions & seizures
Correlation analysis
Correlation coefficient
Correlation coefficients
Drug Resistant Epilepsy - complications
Drug Resistant Epilepsy - physiopathology
Drug Resistant Epilepsy - surgery
Epilepsy
Female
Functional magnetic resonance imaging
Humans
Localization
Magnetic Resonance Imaging
Male
Neural Pathways - physiopathology
NMR
Nuclear magnetic resonance
Postoperative Period
Predictive Value of Tests
Prospective Studies
Resonance
Rest
Sampling methods
Seizures
Seizures - complications
Seizures - physiopathology
Seizures - surgery
Sensitivity and Specificity
Single-Blind Method
Surgery
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Summary:Objective Postoperative resting‐state functional magnetic resonance imaging (MRI) in children with intractable epilepsy has not been quantified in relation to seizure outcome. Therefore, its value as a biomarker for epileptogenic pathology is not well understood. Methods In a sample of children with intractable epilepsy who underwent prospective resting‐state seizure onset zone (SOZ)‐targeted epilepsy surgery, postoperative resting‐state functional MRI (rs‐fMRI) was performed 6 to 12 months later. Graded normalization of the postoperative resting‐state SOZ was compared to seizure outcomes, patient, surgery, and anatomical MRI characteristics. Results A total of 64 cases were evaluated. Network‐targeted surgery, followed by postoperative rs‐fMRI normalization was significantly (p < 0.001) correlated with seizure reduction, with a Spearman rank correlation coefficient of 0.83. Of 39 cases with postoperative rs‐fMRI SOZ normalization, 38 (97%) became completely seizure free. In contrast, of the 25 cases without complete rs‐fMRI SOZ normalization, only 3 (5%) became seizure free. The accuracy of rs‐fMRI as a biomarker predicting seizure freedom is 94%, with 96% sensitivity and 93% specificity. Interpretation Among seizure localization techniques in pediatric epilepsy, network‐targeted surgery, followed by postoperative rs‐fMRI normalization, has high correlation with seizure freedom. This study shows that rs‐fMRI SOZ can be used as a biomarker of the epileptogenic zone, and postoperative rs‐fMRI normalization is a biomarker for SOZ quiescence. ANN NEUROL 2019;86:344–356
ISSN:0364-5134
1531-8249
DOI:10.1002/ana.25547