Miecznikowski Kara B, Greiner Hansel M, Leach James, Rozhkov Leonid, Mangano Francesco T, Krueger Darcy A, DiFrancesco Mark W
University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Epilepsia. 2025 Jun;66(6):1854-1864. doi: 10.1111/epi.18320. Epub 2025 Mar 5.
Patients with tuberous sclerosis complex (TSC)-related epilepsy often have drug-refractory epilepsy and numerous potential epileptogenic tubers. Current clinical methods target tubers for resection, but prediction of resulting seizure relief is difficult. This study describes implementation of lesion network mapping in TSC patients undergoing epilepsy surgery to associate resection zone with seizure outcomes.
Thirty-nine consecutive patients with TSC who underwent invasive electroencephalography (EEG) and resection or ablation of the seizure onset zone were included. After preprocessing, each resection zone was delineated as the region of interest. Lesion network mapping was performed to determine the association between cortical networks connected to the resection zone and postoperative outcome using a multiple regression, iterative model that included demographic and other variables obtained from analysis of invasive EEG.
Of 39 patients, 20 (51%) had a good International League Against Epilepsy outcome (1-3). Resection regions connected to the default mode network and motor network were associated with better seizure outcome. Regions connected to the bilateral insula, visual associative regions, and putamen were associated with poor seizure outcome.
This study provides methodology for lesion network mapping in TSC-related epilepsy. The results suggest a tendency for better outcomes when the resection zone is connected to certain networks, including the default mode and motor networks, that may support sustainment of seizures.
结节性硬化症（TSC）相关癫痫患者通常患有药物难治性癫痫且有众多潜在致痫结节。目前的临床方法以切除结节为目标，但难以预测癫痫发作缓解情况。本研究描述了在接受癫痫手术的TSC患者中实施病灶网络映射，以将切除区域与癫痫发作结果相关联。
纳入39例连续接受有创脑电图（EEG）检查及癫痫发作起始区切除或消融的TSC患者。预处理后，将每个切除区域划定为感兴趣区域。使用多元回归迭代模型进行病灶网络映射，以确定与切除区域相连的皮质网络与术后结果之间的关联，该模型纳入了从有创EEG分析中获得的人口统计学及其他变量。
39例患者中，20例（51%）获得了良好的国际抗癫痫联盟结局（1-3级）。与默认模式网络和运动网络相连的切除区域与更好的癫痫发作结局相关。与双侧岛叶、视觉联合区域和壳核相连的区域与较差的癫痫发作结局相关。
本研究提供了TSC相关癫痫病灶网络映射的方法。结果表明，当切除区域与某些网络（包括默认模式网络和运动网络）相连时，可能支持癫痫发作持续，此时结局有更好的趋势。
