PPubMed10 Jun 2025Cited 3×

Combined impact of gray and superficial white matter abnormalities: Implications for epilepsy surgery Kozma et al.

Csaba Kozma, Jonathan Horsley, Gerard Hall, Callum Simpson, Jane de Tisi, Anna Miserocchi, Andrew W. McEvoy, Sjoerd B. Vos, Gavin P. Winston, Yujiang Wang, John S. Duncan, Peter N. Taylor

Abstract

1. Abnormalities in both gray matter (GM) and superficial white matter (SWM) are found in patients with epilepsy, helping inform surgical decisions. 2. Incorporating both GM and SWM together improves surgical outcome differentiation. 3. Removing concordant abnormal regions further increases the rate of living without disabling seizures. 1## INTRODUCTION Approximately half of the people who undergo epilepsy surgery still experience seizures postoperatively, likely due to incomplete resection of the epileptogenic zone. Successful outcomes depend on the precise localization and removal or disconn

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Combining gray‑matter and superficial white‑matter abnormalities improves seizure‑free outcomes after epilepsy surgery, with 100% success when all concordant abnormal regions are removed.

What’s new

i.Showed that resecting gray‑matter or superficial white‑matter abnormalities individually influences surgical outcomes
ii.Demonstrated that combining both modalities yields better outcome discrimination (AUC = 0.72)
iii.Found that complete removal of concordant abnormal regions leads to 100% ILAE 1‑2 seizure‑free outcomes
iv.Developed a multimodal abnormality mapping pipeline using z‑scores against healthy controls

How they did it

A retrospective cohort of 143 temporal‑lobe epilepsy patients and 97 controls underwent pre‑operative T1‑weighted and diffusion MRI. Gray‑matter volume and superficial white‑matter mean diffusivity were z‑scored against controls to identify abnormalities, and the proportion of abnormal regions resected was calculated. Outcome discrimination was assessed with ROC AUC and logistic regression.

What they found

GM abnormality resection AUC = 0.68 (p < 0.01)
SWM abnormality resection AUC = 0.65 (p < 0.01)
Combined GM + SWM (union) AUC = 0.72 (p < 0.01)
Concordant abnormal region resection AUC = 0.64 (p = 0.04)
100% of patients with all concordant abnormal ROIs resected achieved ILAE 1‑2 outcomes
73.4% of the whole cohort achieved ILAE 1‑2 outcomes at 12 months

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