MRI Connectome Hub Disruption Predicts Long-Term Seizure Recurrence After Temporal Lobe Epilepsy Surgery

In 175 patients, a preoperative MRI connectome model predicted long-term seizure recurrence after temporal lobe epilepsy surgery with 80.0% specificity and 63.9% negative predictive value, outperforming clinical variables.

• Multicenter prospective cohort of 175 patients with drug-resistant temporal lobe epilepsy (mean follow-up 5.4 years) who underwent resective or laser ablative surgery.
• Multimodal structural and functional connectome model achieved high specificity (mean 80.0%, SD 9.9%) and moderate-to-high negative predictive value (63.9%, SD 3.6%), validated in an independent cohort.
• Model highlighted disruption in hippocampi and dorsal attention network connector hubs, including areas not typically targeted in epilepsy surgery, as predictive of recurrence.

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