Thalamic organization differentially contributes to clinical conditions in epilepsy.

Authors

• Qirui Zhang
• Sam S Javidi
• Ankeeta Ankeeta
• Michael R Sperling
• Zhiqiang Zhang
• Joseph I Tracy

Publication/Presentation Date

3-24-2026

Abstract

BACKGROUND: The thalamus plays an important role in key clinical conditions of focal temporal lobe epilepsy (TLE), but no investigation has examined whether the same thalamic local and connectome properties shape a patient's status across these different conditions.

METHODS: This retrospective longitudinal MRI study used resting-state fMRI and structural imaging to identify whole-brain focal/regional and connectome-level features associated with six binary clinical conditions of TLE (pre/post-surgery, seizure and neurocognitive outcomes, pathology, seizure subtype, and SOZ lateralization) in 91 patients across two centers (age range: 15-65 years) and 85 matched healthy participants (age range: 18-60 years).

RESULTS: Across conditions, relative to all other brain regions, thalamic features exert the strongest influence. Specifically, thalamic focal and connectome intrinsic activity and gray matter volume are robustly associated with post-surgical reorganization. Pre-surgical thalamic hyperconnectivity predicts poorer seizure control, whereas post-surgical reorganization is not associated with either seizure outcome. Neuropsychological outcomes are subsequently examined and show associations with local ipsilateral thalamic properties. Namely, pre-surgical organization of the ipsilateral thalamus is associated with better preservation of cognitive performance, whereas post-surgical organization is associated with greater cognitive decline.

CONCLUSIONS: Our results expand and refine our understanding of the thalamus as a region showing robust and recurrent associations across multiple clinical conditions of TLE. Importantly, we distinguish its role in pre- versus post-surgical brain organization with respect to seizure and neuropsychological outcomes, highlighting its importance for planning and prognosis in epilepsy surgery.

Volume

6

Issue

1

ISSN

2730-664X

Published In/Presented At

Zhang, Q., Javidi, S. S., Ankeeta, A., Sperling, M. R., Zhang, Z., & Tracy, J. I. (2026). Thalamic organization differentially contributes to clinical conditions in epilepsy. Communications medicine, 6(1), 281. https://doi.org/10.1038/s43856-026-01530-9

Disciplines

Medicine and Health Sciences

PubMedID

41876841

Department(s)

Department of Medicine

Document Type

Article