Voxel-Based Morphometric MRI Postprocessing-Assisted Laser Interstitial Thermal Therapy for Focal Cortical Dysplasia-Suspected Lesions: Technique and Outcomes.

BACKGROUND: MRI-guided laser interstitial thermal therapy (MRgLITT) is a novel treatment modality for focal cortical dysplasia (FCD). However, identifying the location and extent of subtle FCD by visual analysis during MRgLITT remains challenging. OBJECTIVE: To introduce voxel-based morphometric MRI postprocessing into the procedure of MRgLITT for FCD-suspected lesions and assess the complementary value of the MRI postprocessing technique for the trajectory design and thermal parameter setting of MRgLITT. METHODS: Junction and normalized fluid-attenuated inversion recovery signal intensity images were used to detect the gray-white matter junction blurring and cortical fluid-attenuated inversion recovery hyperintensity, respectively. According to the 2 postprocessing images, the region of interest (ROI) for ablation was drawn. The main principle of presurgical planning is that the trajectory of the laser fiber was designed as far as possible along the long axis of the ROI while the extent of planned ablation covered the entire ROI. The subsequent intraoperative procedure was performed under the guidance of the presurgical plan. RESULTS: Nine patients with epilepsy with FCD-suspected lesions underwent MRgLITT with the assistance of MRI postprocessing images. Among them, 4 patients were junction positive, 2 patients were normalized fluid-attenuated inversion recovery signal intensity positive, and the remaining 3 patients were positive for both. Postsurgical MRI demonstrated that the ROIs were ablated entirely in 7 patients. Engel Ia, Ib, and IV scores were obtained at 1-year follow-up for 6, 1, and 2 patients, respectively. CONCLUSION: MRI postprocessing provides complementary information for designing the laser fiber trajectory and subsequent ablation for FCDs.

Synchronized Intracranial Electrical Activity and Gait Recording in Parkinson's Disease Patients With Freezing of Gait.

Background: This study aimed to describe a synchronized intracranial electroencephalogram (EEG) recording and motion capture system, which was designed to explore the neural dynamics during walking of Parkinson's disease (PD) patients with freezing of gait (FOG). Preliminary analysis was performed to test the reliability of this system. Methods: A total of 8 patients were enrolled in the study. All patients underwent bilateral STN-DBS surgery and were implanted with a right subdural electrode covering premotor and motor area. Synchronized electrophysiological and gait data were collected using the Nihon Kohden EEG amplifier and Codamotion system when subjects performed the Timed Up and Go (TUG) test. To verify the reliability of the acquisition system and data quality, we calculated and compared the FOG index between freezing and non-freezing periods during walking. For electrophysiological data, we first manually reviewed the scaled (five levels) quality during waking. Spectra comprising broadband electrocorticography (ECoG) and local field potential (LFP) were also compared between the FOG and non-FOG states. Lastly, connectivity analysis using coherence between cortical and STN electrodes were conducted. In addition, we also use machine learning approaches to classified FOG and non-FOG. Results: A total of 8 patients completed 41 walking tests, 30 of which had frozen episodes, and 21 of the 30 raw data were level 1 or 2 in quality (70%). The mean ± SD walking time for the TUG test was 85.94 ± 47.68 s (range: 38 to 190.14 s); the mean ± SD freezing duration was 12.25 ± 7.35 s (range: 1.71 to 27.50 s). The FOG index significantly increased during the manually labeled FOG period (P < 0.05). The beta power of STN LFP in the FOG period was significantly higher than that in the non-FOG period (P < 0.05), while the band power of ECoG did not exhibit a significant difference between walking states. The coherence between the ECoG and STN LFP was significantly greater in high beta and gamma bands during the FOG period compared with the shuffled surrogates (P < 0.05). Lastly, STN-LFP band power features showed above-chance performance (p < 0.01, permutation test) in identifying FOG epochs. Conclusion: In this study, we established and verified the synchronized ECoG/LFP and gait recording system in PD patients with FOG. Further neural substrates underlying FOG could be explored using the current system.

The effect of influenza A (H1N1) pdm09 virus infection on cytokine production and gene expression in BV2 microglial cells.

Acute influenza infection has been reported to be associated with neurological symptoms such as influenza-associated encephalopathy (IAE). Although the pathophysiology of this condition remain unclear, neuroinflammation and associated alterations in the central nervous system (CNS) are usually induced. Microglia (MGs), CNS-resident macrophages, are generally the first cells to be activated in response to brain infection or damage. We performed reverse transcriptase droplet digital PCR (RT-ddPCR) and luminex assays to investigate virus proliferation and immune reactions in BV2 MGs infected with influenza A(H1N1)pdm09 virus. Furthermore, isobaric tags for relative and absolute quantitation (iTRAQ)-based quantitative proteomics methods were used to investigate the dynamic change in the protein expression profile in BV2 MGs to gain insight into the CNS response to influenza A (H1N1) pdm09 infection. Our results showed that the influenza A(H1N1)pdm09 virus was replicative and productive in BV2 MG cells, which produced cytokines such as interleukin (IL)-1ß, IL-6, tumour necrosis factor (TNF)-α and monocyte chemoattractant protein (MCP)-1. The expression of osteopontin (OPN) in the influenza A (H1N1) pdm09-infected BV2 MGs was upregulated at 16 and 32 h post-infection (hpi) compared to that in the control group, resulting in aggravated brain damage and inflammation. Our study indicates that OPN signalling might provide new insights into the treatment of CNS injury and neurodegenerative diseases in IAE.

Neural networks underlying hyperkinetic seizures: A quantitative PET and SEEG study.

OBJECTIVE: Hyperkinetic seizures (HKS) are characterized by complex movements that commonly occur during seizures arising from diverse cortical structures. A common semiology network may exist and analyzing the anatomo-electrical mechanisms would facilitate presurgical evaluation. Here, quantitative positron emission tomography (PET) and stereoelectroencephalography (SEEG) analysis was used to explore the underlying mechanism of HKS. METHODS: We retrospectively collected patients with epilepsy with HKS between 2014 and 2019. The interictal PET data of patients with epilepsy with HKS were compared with those of 25 healthy subjects using statistical parametric mapping to identify regions with significant hypometabolism. Then, regions of interest (ROI) for SEEG analysis were identified based on the results of PET analysis. Patients in which the ROIs were covered by intracerebral electrodes were selected for further analysis. Stereoelectroencephalography -clinical correlations with latency measurements were analyzed, and we also performed coherence analysis among ROIs both before and during HKS. RESULTS: Based on the inclusion criteria, 27 patients were analyzed. In the PET analysis, significant hypometabolism was observed in the ipsilateral dorsoanterior insular lobe, bilateral mesial frontal lobes (supplementary motor area/middle cingulate cortex, SMA/MCC), and the bilateral heads of the caudate nuclei in patients with HKS compared with the control group (p < 0.001). We selected dorsoanterior insula and SMA/MCC as ROIs for SEEG analysis. Eight patients with 23 HKS events were selected for further analysis. There was a linear correlation between the ictal involvement of both the dorsoanterior insula and SMA/MCC with the onset of HKS. Stereoelectroencephalography analysis indicated alpha range activity seemed more often associated with dorsoanterior insula and SMA/MCC involvement during HKS. CONCLUSIONS: The dorsoanterior insular lobe, mesial frontal lobes (SMA/MCC), and the bilateral heads of the caudate nuclei were probably involved in the generation of HKS. The SEEG analysis further indicated that the occurrence of HKS might be partly associated with synchronized rhythmical alpha activity between dorsoanterior insula and SMA/MCC.

The electroclinical features and surgical outcomes of inferior perisylvian epilepsy.

OBJECTIVE: To summarize the clinical and electrophysiological observations of epilepsy originating from the inferior perisylvian cortex, and analyze the potential epileptic networks underlying the semiological manifestations. METHODS: We retrospectively analyzed patients with refractory inferior perisylvian epilepsy (IPE) who had undergone resective surgery, and then reviewed the demographic, clinical, neuroelectrophysiological, neuroimaging, surgical, histopathological, and follow-up data of the patients from the respective medical records. The selected patients were then categorized in accordance with the results of semiological analysis. Quantitative 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) analysis was performed to investigate the underlying neural network. RESULTS: Of the 18 IPE patients assessed in this study, ipsilateral frontotemporal epileptic discharges or its onsets were the dominant interictal or ictal scalp EEG observations. In addition, oroalimentary or manual automatism was the most frequently documented manifestation, followed by facial tonic or clonic movements. Moreover, the semiological analysis identified and classified the patients into 2 patterns, and the PET statistical analyses conducted on these 2 groups revealed differences in the neural network between them. CONCLUSION: Inferior perisylvian epilepsy possesses semiological manifestations similar to those of mesial temporal lobe epilepsy or rolandic opercular epilepsy, hence these conditions should be carefully differentiated. Performing lesionectomy or cortectomy, sparing the mesial temporal structures, was found to be an effective and safe treatment modality for IPE.

The Rolandic operculum generates different semiologies in insulo-opercular and temporal lobe epilepsies.

PURPOSE: The role of the Rolandic operculum in in mesial temporal lobe epilepsy (MTLE) is to produce oroalimentary automatisms (OAAs). In insulo-opercular epilepsy (IOE), the Rolandic operculum may produce perioral muscle clonic or tonic movements or contractions. This paper aims to confirm the symptomatogenic zone of facial symptoms in IOE and to explain this phenomenon. METHODS: A total of 45 IOE patients and 15 MTLE patients were analyzed. The patients with IOE were divided into facial (+) and (-) groups according to the facial symptoms. The interictal positron emission tomography (PET) data were compared among groups. Furthermore, electroclinical correlation, functional connectivity and energy ratio (ER) were analyzed with stereo-electroencephalography (SEEG). RESULTS: Intergroup PET differences were observed mainly in the Rolandic operculum. Electroclinical correlation showed that the Rolandic operculum was the only brain area showing any correlations. Compared with the facial (-) group, the facial (+) group showed stronger functional connectivity and a higher ER in the alpha 1, alpha 2 and beta sub-bands. In the Rolandic operculum, compared with those of the MTLE group, the h2 and ER of the facial (+) group were higher in the high frequency sub-bands. Intergroup comparison of the ER in the seizure onset zones (SOZ) showed no significant difference. SIGNIFICANCE: The symptomatogenic zone of facial symptoms in IOE is the Rolandic operculum. Seizure propagation to the Rolandic operculum generates different semiologies because of the different synchronization frequencies and energies of the sub-bands depending on the site of seizure origin. This may be due to the complex spreading pathway from the SOZ to the symptomatogenic zone.

Epileptogenic network of focal epilepsies mapped with cortico-cortical evoked potentials.

OBJECTIVE: The goal of this study was to investigate the spatial extent and functional organization of the epileptogenic network through cortico-cortical evoked potentials (CCEPs) in patients being evaluated with intracranial stereoelectroencephalography. METHODS: We retrospectively included 25 patients. We divided the recorded sites into three regions: epileptogenic zone (EZ); propagation zone (PZ); and noninvolved zone (NIZ). The root mean square of the amplitudes was calculated to reconstruct effective connectivity network. We also analyzed the N1/N2 amplitudes to explore the responsiveness influenced by epileptogenicity. Prognostic analysis was performed by comparing intra-region and inter-region connectivity between seizure-free and non-seizure-free groups. RESULTS: Our results confirmed that stimulation of the EZ caused the strongest responses on other sites within and outside the EZ. Moreover, we found a hierarchical connectivity pattern showing the highest connectivity strength within EZ, and decreasing connectivity gradient from EZ, PZ to NIZ. Prognostic analysis indicated a stronger intra-EZ connection in the seizure-free group. CONCLUSION: The EZ showed highest excitability and dominantly influenced other regions. Quantitative CCEPs can be useful in mapping epileptic networks and predicting surgical outcome. SIGNIFICANCE: The generated computational connectivity model may enhance our understanding of epileptogenic networks and provide useful information for surgical planning and prognosis prediction.

Network of ictal head version in mesial temporal lobe epilepsy.

OBJECTIVE: Ictal head version is a common clinical manifestation of mesial temporal lobe epilepsy (MTLE). Nevertheless, the location of the symptomatogenic zone and the network involved in head version remains unclear. We attempt to explain these problems by analyzing interictal 18 FDG-PET imaging and ictal stereo-electroencephalography (SEEG) recordings in MTLE patients. METHODS: Fifty-eight patients with MTLE were retrospectively analyzed. The patients were divided into version (+) and (-) groups according to the occurrence of versive head movements. The interictal PET data were compared among 18 healthy controls and the (+) and (-) groups. Furthermore, epileptogenicity index (EI) values and correlations with the onset time of head version were analyzed with SEEG. RESULTS: Intergroup comparisons showed that PET differences were observed in the middle temporal neocortex (MTN), posterior temporal neocortex (PTN), supramarginal gyrus (SMG), and inferior parietal lobe (IPL). The EI values in the SMG, MTN, and PTN were significantly higher in the version (+) group than in the version (-) group. A linear relationship was observed between head version onset and ipsilateral onset time in the SMG, orbitofrontal cortex (OFC), MTN, and PTN. A linear relationship was observed between EI, the difference between version onset and temporal neocortex onset, and the y-axis of the MNI coordinate. CONCLUSION: The generation of ictal head version contributes to the propagation of ictal discharges to the intraparietal sulcus (IPS) area. The network of version originates from a mesial temporal lobe structure, passes through the MTN, PTN, and SMG, and likely ends at the IPS.

Focal cortical dysplasia II-related seizures originate from the bottom of the dysplastic sulcus: A stereoelectroencephalography study.

OBJECTIVES: Focal cortical dysplasia (FCD) II is a frequently observed histopathological substrate in epilepsy surgery. In the present study, we explored the spatial distribution of epileptogenic activities across FCD II lesions using stereoelectroencephalography. METHODS: Patients with histopathologically confirmed type II FCDs and who had at least one depth electrode that go through the wall of the dysplastic sulcus from the surface to the bottom were included. The dysplastic sulci were divided into the bottom and non-bottom parts manually, and contacts were defined as bottom or non-bottom contacts according to their locations. Factors (bottom location, pathological subtype, magnetic resonance imaging manifestation, and presence of bottom-of-sulcus dysplasia) potentially associated with earliest onset identified by conventional visual analysis, epileptogenicity index (EI), and standardized number of high-frequency oscillations (HFOs) were analyzed. Linear regression analyses between distance (from the location of the analyzed contact to the bottom of the sulcus) and EI value and HFO number were performed. RESULTS: Sixteen patients with 19 depth electrodes containing 112 valid contacts were included. Bottom location was the sole factor significantly associated with earliest onset (P < 0.001), EI value (P < 0.001), and HFO number (P < 0.001). Most earliest onsets were recorded by the bottom contacts, bottom contacts had higher EI value (0.81 ±â€¯0.28 vs. 0.31 ±â€¯0.24, P < 0.001) and more HFOs (0.78 ±â€¯0.28 vs. 0.35 ±â€¯0.31, P < 0.001) than non-bottom contacts. Moreover, the EI value (R = -0.72, P < 0.001) and HFO number (R = -0.64, P < 0.001) were significantly negatively correlated with distance, regardless of histopathological subtype, MRI manifestation, or absence of bottom-of-sulcus dysplasia. CONCLUSION: Seizure onsets and interictal HFOs most often arise from the bottom part of a sulcus with type II FCD. SIGNIFICANCE: The findings of the present study contribute to intracranial electrode selection, trajectory planning, and, later on, resection of this kind of malformation.

Symptomatogenic zone and network of oroalimentary automatisms in mesial temporal lobe epilepsy.

OBJECTIVE: Oroalimentary automatisms (OAAs) are common clinical manifestations of medial temporal lobe epilepsy. Nevertheless, the location of the symptomatogenic zone of OAAs remains unclear. The generation mechanism of OAAs also has not been clarified. We attempt to explain these problems by analyzing interictal [18 F]-fluorodeoxyglucose positron emission tomography (18 FDG-PET) imaging and ictal stereo-electroencephalography (SEEG) recordings in patients with medial temporal lobe epilepsy. METHODS: Fifty-seven patients with mesial temporal lobe epilepsy were analyzed retrospectively. All underwent anterior temporal lobectomy (ATL) and were seizure-free. The patients were divided into OAA (+) and OAA (-) groups according to the occurrence of consistent stereotyped OAAs. The interictal PET data were compared with those of 18 healthy controls and were then compared between groups using statistical parametric mapping (SPM). Functional connectivity using linear regression analysis was performed between the target brain regions. To clarify the network of OAAs, ictal epileptogenicity index (EI) values, and the nonlinear correlation method h2 were performed with SEEG on patients. RESULTS: Compared to OAAs (-), the rolandic operculum was the only area with significant differences. Hippocampus and rolandic operculum showed significant correlations in the OAA (+) group (y = 0.758x+0.470, R2  = 0.456, P = 0.000). No correlation was found in the OAA (-) group (P = 0.486). The EI values of the OAA (+) group (median 0.20) were significantly higher (P < 0.0001) than those of the OAA (-) group (median 0). The h2 in the OAA (+) group (h2  = 0.23 ± 0.13) showed stronger functional connectivity (t = 6.166, P < 0.0001) than that of the OAA (-) group (h2  = 0.08 ± 0.05). SIGNIFICANCE: The rolandic operculum is most likely to be the symptomatogenic zone of OAAs. In medial temporal lobe epilepsy, unilateral functional connection from the hippocampus to the rolandic operculum during seizure onset is the basis for the generation of OAAs.

Motor cortex stimulation: a systematic literature-based analysis of effectiveness and case series experience.

BACKGROUND: Aim to quantitatively analyze the clinical effectiveness for motor cortex stimulation (MCS) to refractory pain. METHODS: The literatures were systematically searched in database of Cocharane library, Embase and PubMed, using relevant strategies. Data were extracted from eligible articles and pooled as mean with standard deviation (SD). Comparative analysis was measured by non-parametric t test and linear regression model. RESULTS: The pooled effect estimate from 12 trials (n = 198) elucidated that MCS shown the positive effect on refractory pain, and the total percentage improvement was 35.2% in post-stroke pain and 46.5% in trigeminal neuropathic pain. There is no statistical differences between stroke involved thalamus or non-thalamus. The improvement of plexus avulsion (29.8%) and phantom pain (34.1%) was similar. The highest improvement rate was seen in post-radicular plexopathy (65.1%) and MCS may aggravate the pain induced by spinal cord injury, confirmed by small sample size. Concurrently, Both the duration of disease (r = 0.233, p = 0.019*) and the time of follow-up (r = 0.196, p = 0.016*) had small predicative value, while age (p = 0.125) had no correlation to post-operative pain relief. CONCLUSIONS: MCS is conducive to the patients with refractory pain. The duration of disease and the time of follow-up can be regarded as predictive factor. Meanwhile, further studies are needed to reveal the mechanism of MCS and to reevaluate the cost-benefit aspect with better-designed clinical trials.

Superior Frontal Sulcus Focal Cortical Dysplasia Type II: An MRI, PET, and Quantified SEEG Study.

Purpose: The superior frontal sulcus (SFS), located in the prefrontal and premotor cortex, is considered as one of the common locations of focal cortical dysplasia (FCD). However, the characteristics of seizures arising from this area are incompletely known. The primary purpose of this study was to investigate the clinical features and the epileptic networks of seizures originating from the SFS. Methods: We included seventeen patients with type II FCD within the SFS. SFS was identified both visually and automatically. Semiological features were evaluated and grouped. Interictal 18FDG-PET imaging in all patients was compared to controls using statistical parametric mapping (SPM-PET). In those subjects with stereoelectroencephalography (SEEG), two different quantitative intracranial electroencephalography analyses were applied. Finally, the locations of the SFS-related hypometabolic regions and epileptogenic zones (EZs) were transformed into standard space for group analysis. Results: We identified two semiological groups. Group 1 (9/17) showed elementary motor signs (head version and tonic posturing), while group 2 (8/17) exhibited complex motor behavior (fear, hypermotor, and ictal pouting). Based on SPM-PET, an SFS-supplementary motor area (SMA) epileptic propagation network was found in group 1, and an SFS-middle cingulate cortex (MCC)-pregenual anterior cingulate cortex (pACC) propagation network was discovered in group 2. Intracranial EEG analysis suggested similar affected structures with high epileptogenicity. The SFS-related hypometabolic regions and EZs in these groups showed a posterior-anterior spatial relationship. Conclusions: Even though originating from the spatially restricted cortex, SFS seizures can be divided into two groups based on semiological features. The SFS-SMA and SFS-MCC-pACC epileptic propagation networks may play pivotal roles in the generation of different semiologies. The posterior-anterior spatial relationship of both hypometabolic regions and EZs provides potentially useful information for distinguishing different types of SFS seizures and surgical evaluation.

Value of stereo-electroencephalogram in reoperation of patients with pharmacoresistant epilepsy: a single center, retrospective study.

PURPOSE: To systematically elucidate the value of stereo-electroencephalogram (SEEG) in the reoperation of patients with pharmacoresistant epilepsy. METHODS: Epilepsy patients who had previously undergone a failed operation and agreed to a reoperation were included in this study. The single center retrospective study evaluated the value of SEEG in epileptogenic zones (EZ) lateralization and localization as well as the complications related to the implantation. RESULTS: In total, fourteen patients met the inclusion criteria and received reoperation after implantation of SEEG. The average number of electrodes in each patient is 7.9. At the last available follow-up, nine (64.3%) patients were completely seizure-free according to the International League Against Epilepsy (ILAE) criteria. No significant complications were found in the cohort, two patients' electrodes were loosened and removed because of the seizure. No significant predictors of seizure-free status were identified in the present study, including the result of presurgical MRI, pathology and surgical strategy. CONCLUSIONS: Based on the comprehensive presurgical assessment data and careful discussion of multidisciplinary team, failed epileptic surgery deserves a second chance. Moreover, SEEG is an effective and safe methodology to determine the location of the EZ with the goal of performing reoperation.

Use of an Automated Quantitative Analysis of Hippocampal Volume, Signal, and Glucose Metabolism to Detect Hippocampal Sclerosis.

Purpose: Magnetic resonance imaging (MRI) and positron emission tomography (PET) with 18F-fluorodeoxyglucose (18FDG) are valuable tools for evaluating hippocampal sclerosis (HS); however, bias may arise during visual analyses. The aim of this study was to evaluate and compare MRI and PET post-processing techniques, automated quantitative hippocampal volume (Q-volume), and fluid-attenuated inversion-recovery (FLAIR) signal (Q-FLAIR) and glucose metabolism (Q-PET) analyses in patients with HS. Methods: We collected MRI and 18FDG-PET images from 54 patients with HS and 22 healthy controls and independently performed conventional visual analyses (CVA) of PET (CVA-PET) and MRI (CVA-MRI) images. During the subsequent quantitative analyses, the hippocampus was segmented from the 3D T1 image, and the mean volumetric, FLAIR intensity and standardized uptake value ratio (SUVR) values of the left and right hippocampus were assessed in each subject. Threshold confidence levels calculated from the mean volumetric, FLAIR intensity and SUVR values of the controls were used to identify healthy subjects or subjects with HS. The performance of the three methods was assessed using receiver operating characteristic (ROC) curves, and the detection rates of CVA-MRI, CVA-PET, Q-volume, Q-FLAIR, and Q-PET were statistically compared. Results: The areas under the curves (AUCs) for the Q-volume, Q-FLAIR, and Q-PET ROC analyses were 0.88, 0.41, and 0.98, which suggested a diagnostic method with moderate, poor, and high accuracy, respectively. Although Q-PET had the highest detection rate among the two CVA methods and three quantitative methods, the difference between Q-volume and Q-PET did not reach statistical significance. Regarding the HS subtypes, CVA-MRI, CVA-PET, Q-volume, and Q-PET had similar detection rates for type 1 HS, and Q-PET was the most sensitive method for detecting types 2 and 3 HS. Conclusions: In MRI or 18FDG-PET images that have been visually assessed by experts, the quantification of hippocampal volume or glucose uptake can increase the detection of HS and appear to be additional valuable diagnostic tools for evaluating patients with epilepsy who are suspected of having HS.

Clinical Value of Machine Learning in the Automated Detection of Focal Cortical Dysplasia Using Quantitative Multimodal Surface-Based Features.

Objective: To automatically detect focal cortical dysplasia (FCD) lesion by combining quantitative multimodal surface-based features with machine learning and to assess its clinical value. Methods: Neuroimaging data and clinical information for 74 participants (40 with histologically proven FCD type II) was retrospectively included. The morphology, intensity and function-based features characterizing FCD lesions were calculated vertex-wise on each cortical surface and fed to an artificial neural network. The classifier performance was quantitatively and qualitatively assessed by performing statistical analysis and conventional visual analysis. Results: The accuracy, sensitivity, specificity of the neural network classifier based on multimodal surface-based features were 70.5%, 70.0%, and 69.9%, respectively, which outperformed the unimodal classifier. There was no significant difference in the detection rate of FCD subtypes (Pearson's Chi-Square = 0.001, p = 0.970). Cohen's kappa score between automated detection outcomes and post-surgical resection region was 0.385 (considered as fair). Conclusion: Automated machine learning with multimodal surface features can provide objective and intelligent detection of FCD lesion in pre-surgical evaluation and can assist the surgical strategy. Furthermore, the optimal parameters, appropriate surface features and efficient algorithm are worth exploring.