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Neurosurg Focus. 2020 Feb 1;48(2):E10. doi: 10.3171/2019.11.FOCUS19765.

Functional and resting-state characterizations of a periventricular heterotopic nodule associated with epileptogenic activity.

Author information

1
Departments of1Neuroscience and.
2
2Neurosurgery, Rockefeller Neuroscience Institute and Center for Advanced Imaging at West Virginia University.
3
3Department of Pediatrics, West Virginia University, Morgantown, West Virginia; and.
4
4Scientific and Statistical Computing Core, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.

Abstract

The object of this study was to extensively characterize a region of periventricular nodular heterotopia (PVNH) in an epilepsy patient to reveal its possible neurocognitive functional role(s). The authors used 3-T MRI approaches to exhaustively characterize a single, right hemisphere heterotopion in a high-functioning adult male with medically responsive epilepsy, which had manifested during late adolescence. The heterotopion proved to be spectroscopically consistent with a cortical-like composition and was interconnected with nearby ipsilateral cortical fundi, as revealed by fiber tractography (diffusion-weighted imaging) and resting-state functional connectivity MRI (rsfMRI). Moreover, the region of PVNH demonstrated two novel characterizations for a heterotopion. First, functional MRI (fMRI), as distinct from rsfMRI, showed that the heterotopion was significantly modulated while the patient watched animated video scenes of biological motion (i.e., cartoons). Second, rsfMRI, which demonstrated correlated brain activity during a task-negative state, uniquely showed directionality within an interconnected network, receiving positive path effects from patent cortical and cerebellar foci while outputting only negative path effects to specific brain foci.These findings are addressed in the context of the impact on noninvasive presurgical brain mapping strategies for adult and pediatric patient workups, as well as the impact of this study on an understanding of the functional cortical architecture underlying cognition from a neurodiversity and evolutionary perspective.

KEYWORDS:

BOLD = blood oxygen level–dependent; DWI = diffusion-weighted imaging; EEG = electroencephalography; MCD = malformation of cortical development; OTS = occipitotemporal sulcus; PVNH = periventricular nodular heterotopia; ROI = region of interest; STS = superior temporal sulcus; SVAR = structural vector autoregression; cognition; diagnostic technique; encephalization; epilepsy; fMRI = functional MRI; neurodiversity; pMTG = posterior middle temporal gyrus; pSTS = posterior STS; rsfMRI = resting-state functional connectivity MRI; surgical preplanning

PMID:
32006947
DOI:
10.3171/2019.11.FOCUS19765

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