The epileptogenic zone in children with tuberous sclerosis complex is characterized by prominent features of focal cortical dysplasia

Abstract Objective Patients with tuberous sclerosis complex (TSC) present with drug‐resistant epilepsy in about 60% of cases, and evaluation for epilepsy surgery may be warranted. Correct delineation of the epileptogenic zone (EZ) among multiple dysplastic lesions on MRI represents a challenging ste...

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Autores principales:	Hanna M. Hulshof, Barbora Benova, Pavel Krsek, Martin Kyncl, Maarten H. Lequin, Anezka Belohlavkova, Petr Jezdik, Kees P. J. Braun, Floor E. Jansen
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	epilepsy surgery focal cortical dysplasia magnetic resonance imaging pre‐surgical evaluation tuberous sclerosis complex Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/9b8a42fcea844aa685ea68c71fae0e56
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spelling	oai:doaj.org-article:9b8a42fcea844aa685ea68c71fae0e562021-12-01T06:09:19ZThe epileptogenic zone in children with tuberous sclerosis complex is characterized by prominent features of focal cortical dysplasia2470-923910.1002/epi4.12529https://doaj.org/article/9b8a42fcea844aa685ea68c71fae0e562021-12-01T00:00:00Zhttps://doi.org/10.1002/epi4.12529https://doaj.org/toc/2470-9239Abstract Objective Patients with tuberous sclerosis complex (TSC) present with drug‐resistant epilepsy in about 60% of cases, and evaluation for epilepsy surgery may be warranted. Correct delineation of the epileptogenic zone (EZ) among multiple dysplastic lesions on MRI represents a challenging step in pre‐surgical evaluation. Methods Two experienced neuroradiologists evaluated pre‐ and post‐surgical MRIs of 28 epilepsy surgery patients with TSC, assessing characteristics of tubers, cysts, calcifications, and focal cortical dysplasia (FCD)—resembling lesions. Utilizing multiple metrics, we compared MRI features of the EZ—defined as the resected area in TSC patients who achieved seizure‐freedom 2 years after epilepsy surgery—with features of other brain areas. Using combinatorial analysis, we identified combinations of dysplastic features that are most frequently observed in the epileptogenic zone in TSC patients. Results All TSC‐associated dysplastic features were more frequently observed in the EZ than in other brain areas (increased cortical thickness, gray‐white matter blurring, transmantle sign, calcifications, and tubers; Kendal's tau 0.35, 0.25, 0.27, 0.26, and 0.23, respectively; P value <.001 in all). No single feature could reliably and independently indicate the EZ in all patients. Conversely, the EZ was indicated by the presence of the combination of three of the following features: tubers, transmantle sign, increased cortical thickness, calcifications, and the largest FCD‐affected area. Out of these, the largest FCD‐affected area emerged as the most reliable indicator of the EZ, combined either with calcifications or tubers. Significance The epileptogenic zone in TSC patients harbors multiple dysplastic features, consistent with focal cortical dysplasia. A specific combination of these features can indicate the EZ and aid in pre‐surgical MRI evaluation in epilepsy surgery candidates with TSC.Hanna M. HulshofBarbora BenovaPavel KrsekMartin KynclMaarten H. LequinAnezka BelohlavkovaPetr JezdikKees P. J. BraunFloor E. JansenWileyarticleepilepsy surgeryfocal cortical dysplasiamagnetic resonance imagingpre‐surgical evaluationtuberous sclerosis complexNeurology. Diseases of the nervous systemRC346-429ENEpilepsia Open, Vol 6, Iss 4, Pp 663-671 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	epilepsy surgery focal cortical dysplasia magnetic resonance imaging pre‐surgical evaluation tuberous sclerosis complex Neurology. Diseases of the nervous system RC346-429
spellingShingle	epilepsy surgery focal cortical dysplasia magnetic resonance imaging pre‐surgical evaluation tuberous sclerosis complex Neurology. Diseases of the nervous system RC346-429 Hanna M. Hulshof Barbora Benova Pavel Krsek Martin Kyncl Maarten H. Lequin Anezka Belohlavkova Petr Jezdik Kees P. J. Braun Floor E. Jansen The epileptogenic zone in children with tuberous sclerosis complex is characterized by prominent features of focal cortical dysplasia
description	Abstract Objective Patients with tuberous sclerosis complex (TSC) present with drug‐resistant epilepsy in about 60% of cases, and evaluation for epilepsy surgery may be warranted. Correct delineation of the epileptogenic zone (EZ) among multiple dysplastic lesions on MRI represents a challenging step in pre‐surgical evaluation. Methods Two experienced neuroradiologists evaluated pre‐ and post‐surgical MRIs of 28 epilepsy surgery patients with TSC, assessing characteristics of tubers, cysts, calcifications, and focal cortical dysplasia (FCD)—resembling lesions. Utilizing multiple metrics, we compared MRI features of the EZ—defined as the resected area in TSC patients who achieved seizure‐freedom 2 years after epilepsy surgery—with features of other brain areas. Using combinatorial analysis, we identified combinations of dysplastic features that are most frequently observed in the epileptogenic zone in TSC patients. Results All TSC‐associated dysplastic features were more frequently observed in the EZ than in other brain areas (increased cortical thickness, gray‐white matter blurring, transmantle sign, calcifications, and tubers; Kendal's tau 0.35, 0.25, 0.27, 0.26, and 0.23, respectively; P value <.001 in all). No single feature could reliably and independently indicate the EZ in all patients. Conversely, the EZ was indicated by the presence of the combination of three of the following features: tubers, transmantle sign, increased cortical thickness, calcifications, and the largest FCD‐affected area. Out of these, the largest FCD‐affected area emerged as the most reliable indicator of the EZ, combined either with calcifications or tubers. Significance The epileptogenic zone in TSC patients harbors multiple dysplastic features, consistent with focal cortical dysplasia. A specific combination of these features can indicate the EZ and aid in pre‐surgical MRI evaluation in epilepsy surgery candidates with TSC.
format	article
author	Hanna M. Hulshof Barbora Benova Pavel Krsek Martin Kyncl Maarten H. Lequin Anezka Belohlavkova Petr Jezdik Kees P. J. Braun Floor E. Jansen
author_facet	Hanna M. Hulshof Barbora Benova Pavel Krsek Martin Kyncl Maarten H. Lequin Anezka Belohlavkova Petr Jezdik Kees P. J. Braun Floor E. Jansen
author_sort	Hanna M. Hulshof
title	The epileptogenic zone in children with tuberous sclerosis complex is characterized by prominent features of focal cortical dysplasia
title_short	The epileptogenic zone in children with tuberous sclerosis complex is characterized by prominent features of focal cortical dysplasia
title_full	The epileptogenic zone in children with tuberous sclerosis complex is characterized by prominent features of focal cortical dysplasia
title_fullStr	The epileptogenic zone in children with tuberous sclerosis complex is characterized by prominent features of focal cortical dysplasia
title_full_unstemmed	The epileptogenic zone in children with tuberous sclerosis complex is characterized by prominent features of focal cortical dysplasia
title_sort	epileptogenic zone in children with tuberous sclerosis complex is characterized by prominent features of focal cortical dysplasia
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/9b8a42fcea844aa685ea68c71fae0e56
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The epileptogenic zone in children with tuberous sclerosis complex is characterized by prominent features of focal cortical dysplasia

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