Objective:

To investigate cortical and subcortical structural abnormalities in drug-naïve children with SeLECTS using multimodal MRI and assess their cognitive associations, highlighting the significance of these findings in understanding the disorder.

Key Findings:

• Increased bilateral pontine gray matter volume in SeLECTS patients compared to controls, suggesting potential neurodevelopmental implications.
• Widespread cortical thinning in frontoparietal and left temporal regions, indicating areas of concern for cognitive function.
• Increased gyrification in right lateral orbitofrontal and left superior frontal gyri, which may relate to cognitive processing.
• Reduced right medial temporal sulcal depth, potentially affecting memory functions.
• Atypical leftward lateralization in supramarginal, angular, and middle occipital gyri, which could influence language processing.
• Positive correlation between right pontine volume and disease duration; negative correlation between left superior frontal gyrification and verbal IQ, emphasizing the relationship between structure and cognitive outcomes.

Interpretation:

The findings indicate a complex pattern of cortical dysmaturation and subcortical structural variations in SeLECTS, suggesting that neuroanatomical changes extend beyond the Rolandic cortex and may significantly impact cognitive functions.

Limitations:

• Cross-sectional design limits causal inferences and may introduce temporal biases.
• Small sample size may affect generalizability of the findings.
• Findings may not apply to patients on antiseizure medications, which could skew results.

Conclusion:

The study provides a framework for understanding the neuroanatomical correlates of SeLECTS, emphasizing the need for future longitudinal studies to explore the relationship between structural abnormalities and cognitive outcomes more thoroughly.