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2015 ; 11
(12
): e1004642
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Predicting Surgery Targets in Temporal Lobe Epilepsy through Structural
Connectome Based Simulations
#MMPMID26657566
Hutchings F
; Han CE
; Keller SS
; Weber B
; Taylor PN
; Kaiser M
PLoS Comput Biol
2015[Dec]; 11
(12
): e1004642
PMID26657566
show ga
Temporal lobe epilepsy (TLE) is a prevalent neurological disorder resulting in
disruptive seizures. In the case of drug resistant epilepsy resective surgery is
often considered. This is a procedure hampered by unpredictable success rates,
with many patients continuing to have seizures even after surgery. In this study
we apply a computational model of epilepsy to patient specific structural
connectivity derived from diffusion tensor imaging (DTI) of 22 individuals with
left TLE and 39 healthy controls. We validate the model by examining
patient-control differences in simulated seizure onset time and network location.
We then investigate the potential of the model for surgery prediction by
performing in silico surgical resections, removing nodes from patient networks
and comparing seizure likelihood post-surgery to pre-surgery simulations. We find
that, first, patients tend to transit from non-epileptic to epileptic states more
often than controls in the model. Second, regions in the left hemisphere
(particularly within temporal and subcortical regions) that are known to be
involved in TLE are the most frequent starting points for seizures in patients in
the model. In addition, our analysis also implicates regions in the contralateral
and frontal locations which may play a role in seizure spreading or surgery
resistance. Finally, the model predicts that patient-specific surgery (resection
areas chosen on an individual, model-prompted, basis and not following a
predefined procedure) may lead to better outcomes than the currently used routine
clinical procedure. Taken together this work provides a first step towards
patient specific computational modelling of epilepsy surgery in order to inform
treatment strategies in individuals.