arXiv subjects

Jonathan Horsley

Publications and source records attributed to Jonathan Horsley.

6 recordsLinked to original sources

arXiv2026

Open diffusion MRI and connectivity data for epilepsy and surgery: The IDEAS II release

Epileptic seizures are generated in cerebral networks that propagate ictal and interictal activity. The structure of cerebral networks underpinning epileptic activity can be inferred from diffusion-weighted MRI (DWI). However, publicly available DWI data in individuals with epilepsy are scarce, and processing is technically challenging due to scan-specific artifacts, limiting research progress. Here, we release raw DWI data from 216 individuals with epilepsy and 98 healthy controls. Subject identifiers align with our previous data release (IDEAS), which includes T1-weighted and FLAIR MRI, surgical details, and long-term seizure outcomes after surgery. Preprocessing reduced distortions and artifacts, while fully processed data include diffusion metric maps in native and template space. We also provide parcellated structural connectomes using multiple atlases and connectivity measures. To illustrate the utility of this IDEAS II data, we replicated ENIGMA consortium findings, observing widespread reductions of fractional anisotropy, particularly ipsilateral to the area of seizure onset. We further demonstrate localised abnormality, and network connectivity using streamline tractography in a patient who subsequently underwent temporal lobe resection. This open dataset offers a comprehensive resource to advance research on structural connectivity and surgical outcomes in epilepsy.

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arXiv2025

Normative Modelling in Neuroimaging: A Practical Guide for Researchers

Normative modelling is an increasingly common statistical technique in neuroimaging that estimates population-level benchmarks in brain structure. It enables the quantification of individual deviations from expected distributions whilst accounting for biological and technical covariates without requiring large, matched control groups. This makes it a powerful alternative to traditional case-control studies for identifying brain structural alterations associated with pathology. Despite the availability of numerous modelling approaches and several toolboxes with pre-trained models, the distinct strengths and limitations of normative modelling make it difficult to determine how and when to implement them appropriately. This review offers practical guidance and outlines statistical considerations for clinical researchers using normative modelling in neuroimaging. Through a worked example using clinical epilepsy data, we outline considerations for responsible implementation of pre-trained normative models, to support their broad and rigorous adoption in neuroimaging research.

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arXiv2025

Combined impact of grey and superficial white matter abnormalities: implications for epilepsy surgery

Drug-resistant focal epilepsy is associated with abnormalities in the brain in both grey matter (GM) and superficial white matter (SWM). However, it is unknown if both types of abnormalities are important in supporting seizures. Here, we test if surgical removal of GM and/or SWM abnormalities relates to post-surgical seizure outcome in people with temporal lobe epilepsy (TLE). We analyzed structural imaging data from 143 TLE patients (pre-op dMRI and pre-op T1-weighted MRI) and 97 healthy controls. We calculated GM volume abnormalities and SWM mean diffusivity abnormalities and evaluated if their surgical removal distinguished seizure outcome groups post-surgically. At a group level, GM and SWM abnormalities were most common in the ipsilateral temporal lobe and hippocampus in people with TLE. Analyzing both modalities together, compared to in isolation, improved surgical outcome discrimination (GM AUC = 0.68, p < 0.01, WM AUC = 0.65, p < 0.01; Union AUC = 0.72, p < 0.01, Concordance AUC = 0.64, p = 0.04). Additionally, 100% of people who had all concordant abnormal regions resected had ILAE$_{1,2}$ outcomes. These findings suggest that regions identified as abnormal from both diffusion-weighted and T1-weighted MRIs are involved in the epileptogenic network and that resection of both types of abnormalities may enhance the chances of living without disabling seizures.

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arXiv2024

Seizure freedom after surgical resection of diffusion-weighted MRI abnormalities

Importance: Many individuals with drug-resistant epilepsy continue to have seizures after resective surgery. Accurate identification of focal brain abnormalities is essential for successful neurosurgical intervention. Current clinical approaches to identify structural abnormalities for surgical targeting in epilepsy do not use diffusion-weighted MRI (dMRI), despite evidence that dMRI abnormalities are present in epilepsy and may relate to the epileptogenic zone. Objective: To investigate whether surgical resection of diffusion abnormalities relates to post-operative seizure freedom. Design: This retrospective case-control study was conducted between 2009 and 2022. Data were acquired at the National Hospital for Neurology and Neurosurgery, UK. Study participants included 200 individuals with drug-resistant focal epilepsy, who underwent resective surgery, and 97 healthy controls used as a normative baseline. Main Outcomes: Spatial overlap between diffusion abnormality clusters and surgical resection masks, and relation to post-surgical outcome. Results: Surgical resections overlapping with the largest abnormal cluster significantly correlated with sustained seizure freedom at 12 months (83% vs 55%; p<0.0001) and over five years (p<0.0001). Notably, resecting only a small proportion of the largest cluster was associated with better seizure outcomes than cases with no resection of this cluster (p=0.008). Furthermore, sparing the largest cluster but resecting other large clusters still improved seizure freedom rates compared to no overlap (p=0.03). Conclusions: Our results suggest that abnormal clusters, identified using dMRI, are integral to the epileptogenic network, and even a partial removal of such an abnormal cluster is sufficient to achieve seizure freedom. The study highlights the potential of incorporating dMRI into pre-surgical planning to improve outcomes in focal epilepsy.

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arXiv2024

Status epilepticus and thinning of the entorhinal cortex

Status epilepticus (SE) carries risks of morbidity and mortality. Experimental studies have implicated the entorhinal cortex in prolonged seizures; however, studies in large human cohorts are limited. We hypothesised that individuals with temporal lobe epilepsy (TLE) and a history of SE would have more severe entorhinal atrophy compared to others with TLE and no history of SE. 357 individuals with drug resistant temporal lobe epilepsy (TLE) and 100 healthy controls were scanned on a 3T MRI. For all subjects the cortex was segmented, parcellated, and the thickness calculated from the T1-weighted anatomical scan. Subcortical volumes were derived similarly. Cohen's d and Wilcoxon rank-sum tests respectively were used to capture effect sizes and significance. Individuals with TLE and SE had reduced entorhinal thickness compared to those with TLE and no history of SE. The entorhinal cortex was more atrophic ipsilaterally (d=0.51, p<0.001) than contralaterally (d=0.37, p=0.01). Reductions in ipsilateral entorhinal thickness were present in both left TLE (n=22:176, d=0.78, p<0.001), and right TLE (n=19:140, d=0.31, p=0.04), albeit with a smaller effect size in right TLE. Several other regions exhibited atrophy in individuals with TLE, but these did not relate to a history of SE. These findings suggest potential involvement or susceptibility of the entorhinal cortex in prolonged seizures.

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arXiv2024

The Imaging Database for Epilepsy And Surgery (IDEAS)

Magnetic resonance imaging (MRI) is a crucial tool to identify brain abnormalities in a wide range of neurological disorders. In focal epilepsy MRI is used to identify structural cerebral abnormalities. For covert lesions, machine learning and artificial intelligence algorithms may improve lesion detection if abnormalities are not evident on visual inspection. The success of this approach depends on the volume and quality of training data. Herein, we release an open-source dataset of preprocessed MRI scans from 442 individuals with drug-refractory focal epilepsy who had neurosurgical resections, and detailed demographic information. The MRI scan data includes the preoperative 3D T1 and where available 3D FLAIR, as well as a manually inspected complete surface reconstruction and volumetric parcellations. Demographic information includes age, sex, age of onset of epilepsy, location of surgery, histopathology of resected specimen, occurrence and frequency of focal seizures with and without impairment of awareness, focal to bilateral tonic-clonic seizures, number of anti-seizure medications (ASMs) at time of surgery, and a total of 1764 patient years of post-surgical follow up. Crucially, we also include resection masks delineated from post-surgical imaging. To demonstrate the veracity of our data, we successfully replicated previous studies showing long-term outcomes of seizure freedom in the range of around 50%. Our imaging data replicates findings of group level atrophy in patients compared to controls. Resection locations in the cohort were predominantly in the temporal and frontal lobes. We envisage our dataset, shared openly with the community, will catalyse the development and application of computational methods in clinical neurology.

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