{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T12:16:27Z","timestamp":1778933787208,"version":"3.51.4"},"reference-count":42,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100005089","name":"Natural Science Foundation of Beijing Municipality","doi-asserted-by":"publisher","award":["L246049"],"award-info":[{"award-number":["L246049"]}],"id":[{"id":"10.13039\/501100005089","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82471496"],"award-info":[{"award-number":["82471496"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Magnetic resonance imaging (MRI)\u2010negative type II focal cortical dysplasia (FCD) is challenging to localize and treat. Emerging evidence suggests that the sulcal bottom is the critical site of epileptogenicity. This study investigated whether MRI\u2010negative type II FCD represents a subtle form of bottom\u2010of\u2010sulcus dysplasia (BOSD) and evaluated the safety and efficacy of sulcus bottom\u2010targeted minimally invasive therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Fifty\u2010eight patients (mean age\u2009=\u200918.0\u2009\u00b1\u200910.0\u2009years, range\u2009=\u20094\u201341) with drug\u2010resistant epilepsy and MRI\u2010negative scans were clinically diagnosed with FCD type II and included in the study. Of these, 27 met inclusion criteria for stereoelectroencephalographic (SEEG) analysis to compare interictal spike counts, high\u2010frequency oscillation (HFO) counts, and epileptogenicity index (EI) values between sulcal bottom and nonbottom contacts. Histopathological analysis (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200915) evaluated the spatial distribution of dysmorphic neurons (DNs) and balloon cells (BCs) using nonphosphorylated neurofilament (SMI32), phospho\u2010S6 ribosomal protein (pS6), and Nestin immunoreactivity. An additional 19 patients received magnetic resonance\u2010guided laser interstitial thermal therapy (MRgLITT) targeting the sulcal bottom, with seizure outcomes and ablation coverage systematically evaluated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      SEEG demonstrated significantly higher spike counts, HFOs, and EI values at sulcal bottom contacts than at nonbottom regions (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.0001), showing strong negative correlations with distance from the sulcal bottom (\n                      <jats:italic>R<\/jats:italic>\n                      \u2009=\u2009\u2013.85 to \u2013.68). Histopathology revealed a consistent spatial gradient, with DN density and diaminobenzidine intensity significantly enriched at the sulcal bottom across SMI32 and pS6 labeling (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.05). BCs, when present, were confined to the sulcal bottom. In the MRgLITT cohort, sulcus bottom\u2010targeted ablation achieved seizure freedom (Engel IA) in 73.7% of patients, with a mean ablation coverage of 28.3% and no permanent neurological deficits.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>MRI\u2010negative type II FCD exhibits sulcus bottom\u2010centered epileptogenicity, consistent with a subtle form of BOSD. These findings support sulcus bottom\u2010targeted MRgLITT as a safe and effective minimally invasive therapy and provide a rationale for sulcus bottom\u2010centered surgical planning in MRI\u2010negative FCD II.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi.70124","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T16:22:54Z","timestamp":1769530974000},"page":"2145-2158","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>Magnetic resonance imaging<\/scp>\n                    \u2010negative type\n                    <scp>II<\/scp>\n                    focal cortical dysplasia as a subtle form of bottom\u2010of\u2010sulcus dysplasia: Electrophysiological and histopathological evidence and treatment implications"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5205-1380","authenticated-orcid":false,"given":"Weiyuan","family":"Luo","sequence":"first","affiliation":[{"name":"Beijing Neurosurgical Institute Capital Medical University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Pathology, Beijing Tiantan Hospital Capital Medical University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiangzhi","family":"Lu","sequence":"additional","affiliation":[{"name":"Beijing Neurosurgical Institute Capital Medical University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0920-6825","authenticated-orcid":false,"given":"Baotian","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital Capital Medical University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital Capital Medical University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4800-6706","authenticated-orcid":false,"given":"Xiu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital Capital Medical University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9721-1378","authenticated-orcid":false,"given":"Jiajie","family":"Mo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Tiantan Hospital Capital Medical University  Beijing 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