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Lookup NU author(s): Dr Jonathan Horsley, Dr Gerard HallORCiD, Callum Simpson, Csaba Kozma, Dr Rhys ThomasORCiD, 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: Successful epilepsy surgery requires accurate localization and removal of the epileptogenic zone. Neuroimaging helps detect structural brain abnormalities to guide surgery, but current clinical practice does not use diffusion-weighted magnetic resonance imaging (dwMRI). However, previous work has shown that diffusion abnormalities are present in epilepsy and may relate to the epileptogenic zone. Here, we investigate whether surgical resection of diffusion abnormalities relates to postoperative seizure freedom. Methods: We investigated the association between surgical resection of diffusion abnormalities and postoperative seizure freedom in 200 individuals with drug-resistant focal epilepsy using dwMRI. A cohort of 97 healthy controls provided a normative baseline for dwMRI metrics, allowing calculation of voxelwise z-scores to identify abnormal clusters in both gray and white matter. Results: Surgical resections overlapping with the largest abnormal cluster significantly correlated with sustained seizure freedom at 12 months (83% vs. 55%; (Formula presented.)) and over 5 years ((Formula presented.)). Notably, resecting only a small proportion of the largest cluster was associated with better seizure outcomes than cases with no resection of this cluster ((Formula presented.)). Furthermore, sparing the largest cluster but resecting other large clusters still improved seizure freedom rates compared to no overlap ((Formula presented.)). Significance: Our results suggest that abnormal clusters, identified using dwMRI, are integral to the epileptogenic network, and even a partial removal of such an abnormal cluster is sufficient to achieve seizure freedom. This study highlights the potential of incorporating dwMRI into presurgical planning to improve outcomes in focal epilepsy by reliably identifying and targeting diffusion abnormalities.
Author(s): Horsley J, Hall G, Simpson C, Kozma C, Thomas R, Wang Y, de Tisi J, Miserocchi A, McEvoy A, Vos S, Winston G, Duncan J, Taylor PN
Publication type: Article
Publication status: Published
Journal: Epilepsia
Year: 2025
Volume: 66
Issue: 9
Pages: 3480-3490
Print publication date: 01/09/2025
Online publication date: 10/06/2025
Acceptance date: 19/05/2025
Date deposited: 25/06/2025
ISSN (print): 0013-9580
ISSN (electronic): 1528-1167
Publisher: John Wiley and Sons Inc.
URL: https://doi.org/10.1111/epi.18490
DOI: 10.1111/epi.18490
Data Access Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
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