Epilepsy Surgery and Neuroimaging Techniques

Epilepsy surgery aims to resect or ablate epileptogenic tissue in patients with drug-resistant focal epilepsy. Surgical approaches have evolved from open resections to minimally invasive techniques such as stereoelectroencephalography-guided laser interstitial thermal therapy. Advanced neuroimaging is central to presurgical evaluation, integrating structural and functional modalities to delineate epileptogenic zones. High-resolution MRI identifies structural lesions including hippocampal sclerosis and focal cortical dysplasia. Functional MRI and positron emission tomography map eloquent cortex and metabolic abnormalities, guiding safe resections. Single-photon emission computed tomography and magnetoencephalography enhance localisation in complex cases. Innovations in image integration have facilitated frameless stereotactic electrode placement for intracranial recordings. Recent developments in optical technologies and computational analysis have improved detection of subtle malformations. The global adoption of these techniques has refined patient selection and postoperative outcomes, reducing morbidity while maximising seizure freedom. Interdisciplinary teams now routinely combine genetic, imaging and electrophysiological data to personalise surgical strategy, underscoring the transformative impact of neuroimaging on epilepsy surgery.

Research from Nature Portfolio

Recent studies have identified novel targets and therapeutic strategies within the epileptic network. Work with a translatable mouse and human cohort pinpointed the fasciola cinereum of the posterior hippocampal tail as a key seizure node, demonstrating that closed-loop optogenetic inhibition or targeted lesioning of this region markedly reduces seizure duration beyond traditional anterior mesial temporal interventions. Parallel investigations in cortical malformation models revealed that senescent neuronal populations in mTOR-related focal cortical dysplasia are susceptible to senolytic agents, with selective ablation of pathological cells reducing seizure frequency in preclinical studies. These findings open avenues for adjunctive therapies that complement structural resection by modulating aberrant cellular pathology.

Epilepsy Surgery and Neuroimaging Techniques publication trend

The graph below shows the total number of articles in epilepsy surgery and neuroimaging techniques across all publications each year (not limited to Nature Index journals).

Technical terms

Focal cortical dysplasia (FCD): A congenital malformation of cortical development characterised by dysmorphic neurons and disrupted lamination that often underlies drug-resistant epilepsy.

Stereoelectroencephalography (SEEG): An invasive method of intracranial electroencephalographic monitoring using depth electrodes to localise epileptogenic zones.

Laser interstitial thermal therapy (LITT): A minimally invasive technique using MRI-guided laser energy to thermally ablate epileptogenic tissue.

Senolytic drugs: Pharmacological agents that selectively induce apoptosis in senescent cells to mitigate pathological tissue changes.

Fasciola cinereum: A subregion of the hippocampal tail implicated as a critical node in seizure propagation.

References

1. The fasciola cinereum of the hippocampal tail as an interventional target in epilepsy. Nature Medicine (2024).
2. Targeting pathological cells with senolytic drugs reduces seizures in neurodevelopmental mTOR-related epilepsy. Nature Neuroscience (2024).
3. Personalized Human Astrocyte‐Derived Region‐Specific Forebrain Organoids Recapitulate Endogenous Pathological Features of Focal Cortical Dysplasia. Advanced Science (2024).
4. The long-term outcomes of epilepsy surgery. PLOS ONE (2018).
5. Getting the best outcomes from epilepsy surgery. Annals of Neurology (2018).
6. A Novel Method for Implementation of Frameless StereoEEG in Epilepsy Surgery. Neurosurgery (2014).
7. Novel surface features for automated detection of focal cortical dysplasias in paediatric epilepsy. NeuroImage Clinical (2016).