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Classification and Lateralization of Temporal Lobe Epilepsies with and without Hippocampal Atrophy Based on Whole-Brain Automatic MRI Segmentation

In temporal lobe epilepsy, detecting hippocampal sclerosis (HS) changes management from medical to surgical; yet HS may escape visual detection, with some patients having entirely normal MRI (nMRI) even on specialist assessment. Using automatic segmentation methods we previously developed [Heckemann, Neuroimage, 2006, >300 citations] on images of controls and patients with HS or nMRI we detected HS, distinguished patients with nMRI from controls, and correctly lateralised the epileptogenic zone with ~94% accuracy. We demonstrated, for the first time, morphological abnormalities of the Substantia Nigra (seat of the dopamine system) and how these contributed to the classification, with potential therapeutic implications.