Prediction of post-surgical seizure outcome in left mesial temporal lobe epilepsy.
Prediction of post-surgical seizure outcome in left mesial temporal lobe epilepsy.
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DOI：
10.1016/j.nicl.2013.06.010
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发表时间：
2013
影响因子：
4.2
通讯作者：
Weber, Bernd
中科院分区：
文献类型：
--
作者：
Feis, Delia-Lisa;Schoene-Bake, Jan-Christoph;Elger, Christian;Wagner, Jan;Tittgemeyer, Marc;Weber, Bernd
关键词：
内侧颞叶癫痫是最常见的局灶性癫痫类型，在其过程中往往成为难治性抗惊厥药物治疗。在这些病例中，切除内侧颞叶结构是一个很有前途的选择。然而，大约30%的患者在手术后仍然持续癫痫发作。换句话说，缺乏对患者结局进行预测的可靠标准。为了解决这一局限性，我们研究了单侧内侧颞叶癫痫患者的术前脑形态学，这些患者接受了选择性杏仁核切除术。使用支持向量分类，我们的目的是预测手术后癫痫发作的结果的基础上，术前T1加权脑结构图像的每一个病人。由于形态性别差异和证据表明，男性和女性在发病，患病率和神经系统疾病，在大多数，我们调查了男性和女性患者分开。因此，我们受益于在两个独立样本中验证我们方法可靠性的能力。值得注意的是，我们能够准确地预测男性（94%的平衡准确度）和女性（96%的平衡准确度）组中个体患者的结局。在男性队列中，与非有利结局组相比，在双侧扣带束、额枕束和两个尾状核中确定了有利结局组中相对较大的白色物质体积，而在非有利结局组中，左侧下纵束显示出相对较大的白色物质体积。虽然女性队列中左下和右中纵束中相对较大的白色物质体积与有利结局相关，但不良结局组中相对较大的白色物质体积在双侧上级纵束I和II中确定。在这里，我们观察到一个明确的偏侧化和区别的结构参与分类的男性相比，女性与男性表现出更多的改变，在半球对侧的癫痫发作的重点。总之，基于单个T1加权磁共振图像的个体术后结局预测似乎是合理的，因此可能支持癫痫患者的常规术前检查。T1加权MRI和SVM预测杏仁核切除术后的结果。患者的个体结局预测显示出高灵敏度和特异性。确定了切除边缘外的神经解剖区域。一个强大的和患者特异性的术前预测手术结果。
Mesial temporal lobe epilepsy is the most common type of focal epilepsy and in its course often becomes refractory to anticonvulsant pharmacotherapy. A resection of the mesial temporal lobe structures is a promising option in these cases. However, approximately 30% of all patients remain with persistent seizures after surgery. In other words, reliable criteria for patients' outcome prediction are absent. To address this limitation, we investigated pre-surgical brain morphology of patients with unilateral left mesial temporal lobe epilepsy who underwent a selective amygdalohippocampectomy. Using support vector classification, we aimed to predict the post-surgical seizure outcome of each patient based on the pre-surgical T1-weighted structural brain images. Due to morphological gender differences and the evidence that men and women differ in onset, prevalence and symptomology in most neurological diseases, we investigated male and female patients separately. Thus, we benefitted from the capability to validate the reliability of our method in two independent samples. Notably, we were able to accurately predict the individual patients' outcome in the male (94% balanced accuracy) as well as in the female (96% balanced accuracy) group. In the male cohort relatively larger white matter volumes in the favorable as compared to the non-favorable outcome group were identified bilaterally in the cingulum bundle, fronto-occipital fasciculus and both caudate nuclei, whereas the left inferior longitudinal fasciculus showed relatively larger white matter volume in the non-favorable group. While relatively larger white matter volumes in the female cohort in the left inferior and right middle longitudinal fasciculus were associated with the favorable outcome, relatively larger white matter volumes in the non-favorable outcome group were identified bilaterally in the superior longitudinal fasciculi I and II. Here, we observed a clear lateralization and distinction of structures involved in the classification in men as compared to women with men exhibiting more alterations in the hemisphere contralateral to the seizure focus. In conclusion, individual post-surgical outcome predictions based on a single T1-weighted magnetic resonance image seem plausible and may thus support the routine pre-surgical workup of epilepsy patients. T1-weighted MRI and SVM predict outcome after amygdalohippocampectomy. Patients' individual outcome predictions reveal high sensitivity and specificity. Neuroanatomical regions outside the margins of resection were identified. A robust and patient-specific pre-surgical prediction of surgery outcome is presented.
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影响因子：
14.5
作者：
Kloeppel, Stefan;Stonnington, Cynthia M.;Chu, Carlton;Draganski, Bogdan;Scahill, Rachael I.;Rohrer, Jonathan D.;Fox, Nick C.;Jack, Clifford R., Jr.;Ashburner, John;Frackowiak, Richard S. J.
通讯作者：
Frackowiak, Richard S. J.
影响因子：
11
作者：
Bien, Christian G.;Raabe, Anna L.;Elger, Christian E.
通讯作者：
Elger, Christian E.
影响因子：
5.7
作者：
Focke, Niels K.;Yogarajah, Mahinda;Duncan, John S.
通讯作者：
Duncan, John S.
影响因子：
5.6
作者：
Engel, J
通讯作者：
Engel, J
影响因子：
5.6
作者：
Faber, Jennifer;Schoene-Bake, Jan-Christoph;Weber, Bernd
通讯作者：
Weber, Bernd