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Lookup NU author(s): Csaba Kozma, Dr Jonathan Horsley, Dr Gerard HallORCiD, Callum Simpson, Professor Yujiang WangORCiD, Professor Peter TaylorORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2025 The Author(s). Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy. Objective: Drug-resistant focal epilepsy is associated with abnormalities in the brain in both gray matter (GM) and superficial white matter (SWM). However, it is unknown if both types of abnormalities are important in supporting seizures. Here, we test if surgical removal of GM and/or SWM abnormalities relates to post-surgical seizure outcome in people with temporal lobe epilepsy (TLE). Methods: We analyzed structural imaging data from 143 patients with TLE (pre-op diffusion magnetic resonance imaging and pre-op T1-weighted MRI) and 97 healthy controls. We calculated GM volume abnormalities and SWM mean diffusivity abnormalities and evaluated if their surgical removal distinguished seizure outcome groups post-surgically. Results: At a group level, GM and SWM abnormalities were most common in the ipsilateral temporal lobe and hippocampus in people with TLE. Analyzing both modalities together, compared to in isolation, improved surgical outcome discrimination (GM area under the curve [AUC] = 0.68, p < 0.01; WM AUC = 0.65, p < 0.01; Union AUC = 0.72, p < 0.01; Concordance AUC = 0.64, p = 0.04). In addition, 100% of people who had all concordant abnormal regions resected had International League Against Epilepsy (ILAE)1,2 outcomes. Significance: Resecting abnormalities in GM or SWM individually affects surgical outcomes but combining both provides clearer patient group distinctions. This approach improves outcome differentiation, showing higher rates of patients living without disabling seizures when all concordant abnormal regions are resected. These findings suggest that regions identified as abnormal from both diffusion-weighted and T1-weighted MRI are involved in the epileptogenic network and that resection of both types of abnormalities may enhance the chances of living without disabling seizures.
Author(s): Kozma C, Horsley J, Hall G, Simpson C, de Tisi J, Miserocchi A, McEvoy AW, Vos SB, Winston GP, Wang Y, Duncan JS, Taylor PN
Publication type: Article
Publication status: Published
Journal: Epilepsia
Year: 2025
Pages: Epub ahead of print
Online publication date: 10/06/2025
Acceptance date: 21/05/2025
Date deposited: 24/06/2025
ISSN (print): 0013-9580
ISSN (electronic): 1528-1167
Publisher: John Wiley and Sons Inc.
URL: https://doi.org/10.1111/epi.18494
DOI: 10.1111/epi.18494
Data Access Statement: Code and data to reproduce figures in the manuscript will be made available upon acceptance of the paper.
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