Mapping lesions causing epilepsy to a common brain circuit
Abstract number :
877
Submission category :
2. Translational Research / 2A. Human Studies
Year :
2020
Submission ID :
2423211
Source :
www.aesnet.org
Presentation date :
12/7/2020 1:26:24 PM
Published date :
Nov 21, 2020, 02:24 AM
Authors :
Frederic Schaper, Berenson-Allen Center for Noninvasive Brain Stimulation, Harvard Medical School; Janne Nordberg - Turku Brain and Mind Center, University of Turku; Alex Cohen - Boston Children’s Hospital, Harvard Medical School; Joey Hsu - University of
Rationale:
Treatment of drug-resistant focal epilepsy has traditionally focused on the epileptogenic zone. However, epilepsy is a disease of brain networks and the large-scale brain networks involved in the cause and control of epilepsy in humans remain largely unknown.
Method:
We studied 1153 brain lesions, including 4 lesion types (stroke, tumor, penetrating head trauma, and tubers) associated with structural epilepsy (28%, n=324) or not (72%, n=829), which were shared by collaborators around the world. Lesion locations were mapped to a common brain atlas and the network of brain regions functionally connected to each lesion location was computed using the human connectome (Fox 2018, NEJM). Connections associated with structural epilepsy were identified. We investigated the relevance of these connections in MRI-negative epilepsy using stereo-EEG data (2692 recording sites, n=23) and their therapeutic relevance using data from patients who received thalamic deep brain stimulation for drug-resistant epilepsy (n=30).
Results:
Lesions causing structural epilepsy map to a specific brain circuit defined by connectivity to the cerebellum, substantia nigra reticulata and globus pallidus internus (fwe p < 0.0001). Using a rigorous leave-one-lesion-type out cross-validation, damage to this circuit was significantly associated with the risk of epilepsy (p < 0.0001, relative risk 2.79 [CI: 1.81 – 3.11]). Connectivity to this same circuit was associated with seizure-onset zones in MRI-negative epilepsy (fwe p < 0.01) and with therapeutic response to thalamic deep brain stimulation (fwe p < 0.01).
Conclusion:
Lesions causing structural epilepsy map to a specific brain circuit, that may have prognostic value in predicting the risk for epilepsy after a brain lesion, and therapeutic value as a neuromodulation target for patients with drug-resistant epilepsy.
References
Fox, M. D. (2018). Mapping Symptoms to Brain Networks with the Human Connectome. The New England Journal of Medicine, 379(23), 2237–2245.
Funding:
:This research project did not receive any specific funding.
Translational Research