Neuronal Coupling Between Subcortical Structure and Temporal Lobe Structures in Patients with Drug Resistant Temporal Lobe Epilepsy
Abstract number :
2.384
Submission category :
9. Surgery / 9A. Adult
Year :
2025
Submission ID :
488
Source :
www.aesnet.org
Presentation date :
12/7/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Chandana Belly, MS – University of Pittsburgh Medical Center
Thandar Aung, MD,MS – University of Pittsburgh Medical School
Jian Li, PhD – Massachusetts General Hospital
Tipakorn Tumnark, MD – University of Pittsburgh Medical Center
Jorge González-Martínez, MD,PhD – University of Pittsburgh Medical School
Birgit Frauscher, M.D. Ph.D. – Duke University
Rationale: Temporal lobe epilepsy (TLE) is the most common type of focal drug-resistant epilepsy (DRE), with anterior temporal lobectomy (ATL) considered the gold standard treatment—particularly in patients with mesial temporal sclerosis (MTS). However, despite thorough pre-surgical evaluations, 20–40% of patients, including those with MTS, do not achieve sustained seizure freedom, and many experience a decline in outcomes over time. Recent imaging and stereo-EEG (SEEG) studies have increasingly emphasized the role of the thalamic nuclei—especially the pulvinar—in TLE. Enhanced thalamo-temporal correlation or coupling, particularly between the pulvinar and mesial temporal structures, has been observed during seizures. Early synchronization between the thalamus and cortical regions has been associated with focal to bilateral tonic-clonic (FBTC) seizures and poorer surgical outcomes, indicating that early thalamic involvement may reflect a more widespread epileptic network. Therefore, in our study, we aimed to investigate the correlation between the pulvinar and DR-TLE to determine whether the pulvinar plays a significant role in the pathophysiology of the disease.
Methods: A retrospective study was conducted with IRB approval at the University of Pittsburgh. Between December 2022 and December 2024, 72 patients underwent stereo-electroencephalography (SEEG) evaluation. From this cohort, we consecutively enrolled patients with confirmed temporal lobe epilepsy (TLE) who had electrodes placed in the pulvinar nuclei. For each seizure, 40 seconds of SEEG data were extracted—20 seconds before and 20 seconds after seizure onset. Additionally, 40 seconds of baseline SEEG data were collected at least two minutes prior to seizure onset. Time-frequency analysis was performed using the Morlet wavelet transform, and the resulting ictal data were normalized against the baseline activity. Correlation values were then calculated between ipsilateral pulvinar and ipsilateral mesial temporal electrodes. Seizure freedom was defined as achieving an Engel Class IA outcome at two-year follow-up.
Results: A total of 21 consecutive patients with drug-resistant temporal lobe epilepsy (DR-TLE) and a minimum of two years of follow-up were included in the analysis. Thalamo-temporal correlation was found to be low in patients with nonclinical seizures, and similarly low in patients who achieved seizure freedom. In contrast, patients with clinical seizures and those who did not achieve seizure freedom exhibited significantly higher thalamo-temporal correlations.
Conclusions: These findings suggest that thalamo-temporal connectivity may serve as a potential biomarker for surgical prognosis in temporal lobe epilepsy. However, further studies with larger cohorts are needed to validate its clinical utility and establish its role as a reliable biomarker.
Funding: No funding received in support of this abstract.
Surgery