title: Cortical thickness asymmetries and surgical outcome in neocortical epilepsy.
abstract: OBJECTIVE
  We evaluated if cortical thickness measures were associated with surgical outcome in patients with non-lesional neocortical epilepsy.
  
  
  METHODS
  Twenty-one young patients (age: 2.4-19.7years) with epilepsy of neocortical origin and normal MRI underwent two-stage epilepsy surgery with subdural EEG monitoring. Cortical thickness was measured on presurgical volumetric MRI using the FreeSurfer software. The prognostic value of hemispheric and lobar/regional cortical thickness measures for 1-year and 2-year post-surgical seizure outcome has been analyzed.
  
  
  RESULTS
  At one-year follow-up, 14 patients (67%) were seizure-free. Hemispheric and frontal lobe cortical thickness showed no/minimal asymmetry in seizure-free patients but thinner cortex ipsilateral to the seizure focus in those with recurrent seizures (p=0.02). More robust differences were found in patients≥6years of age (p=0.006 for frontal asymmetries), whose cortical thickness asymmetries remained prognostic for 2-year post-surgical outcome (p=0.007). By using an optimal cutoff threshold based on a receiver operating characteristic analysis, mean hemispheric asymmetry predicted one-year seizure freedom with 93% sensitivity and 71% specificity in the whole group, and with 100% sensitivity and 92% specificity in patients≥6years of age.
  
  
  CONCLUSIONS
  In patients with neocortical epilepsy and normal MRI, neocortical thinning in the epileptic hemisphere, particularly in frontal cortex, is associated with poor surgical outcome. Although these results require validation in a larger cohort prospectively, these data suggest that presurgical evaluation of cortical thickness may assist in identification of patients at high risk for surgical failure.
authors.affiliation: Department of Pediatrics, Wayne State University, 3901 Beaubien St., Detroit, MI 48201, United States; PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, MI 48201, United States.
authors.forename: David O
authors.initials: DO
authors.lastname: Kamson
authors.affiliation: Department of Pediatrics, Wayne State University, 3901 Beaubien St., Detroit, MI 48201, United States; PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, MI 48201, United States.
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Pilli
authors.affiliation: Department of Pediatrics, Wayne State University, 3901 Beaubien St., Detroit, MI 48201, United States; Department of Neurology, Wayne State University, Harper University Hospital, 3990 John R. St, Detroit, MI 48201, United States.
authors.forename: Eishi
authors.initials: E
authors.lastname: Asano
authors.affiliation: Department of Pediatrics, Wayne State University, 3901 Beaubien St., Detroit, MI 48201, United States; PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, MI 48201, United States.
authors.forename: Jeong-Won
authors.initials: JW
authors.lastname: Jeong
authors.affiliation: Department of Pediatrics, Wayne State University, 3901 Beaubien St., Detroit, MI 48201, United States; Department of Neurosurgery, Wayne State University, Harper University Hospital, 3990 John R. St, Detroit, MI 48201, United States.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Sood
authors.affiliation: Department of Pediatrics, Wayne State University, 3901 Beaubien St., Detroit, MI 48201, United States; PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, MI 48201, United States; Department of Neurology, Wayne State University, Harper University Hospital, 3990 John R. St, Detroit, MI 48201, United States. Electronic address: juhasz@pet.wayne.edu.
authors.forename: Csaba
authors.initials: C
authors.lastname: Juhász
authors.affiliation: Department of Pediatrics, Wayne State University, 3901 Beaubien St., Detroit, MI 48201, United States; PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, MI 48201, United States; Department of Neurology, Wayne State University, Harper University Hospital, 3990 John R. St, Detroit, MI 48201, United States.
authors.forename: Harry T
authors.initials: HT
authors.lastname: Chugani
mesh_terms: D000293:Adolescent; D002540:Cerebral Cortex / Q000000981:diagnostic imaging* / Q000254:growth & development / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D000069280:Electrocorticography; D004827:Epilepsy / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D009929:Organ Size; D011379:Prognosis; D012372:ROC Curve; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cortical thickness; Epilepsy; Epilepsy surgery; Frontal lobe; MRI; Surgical outcome