Voxel-based and surface-based morphometric analyses reveal cortical-subcortical structural abnormalities and cognitive correlates in drug-naïve SeLECTS.

Background: Self-limited epilepsy with centrotemporal spikes (SeLECTS) is a common childhood epilepsy syndrome characterized by spontaneous seizure remission but frequent cognitive difficulties. Previous neuroimaging studies have reported cortical abnormalities in SeLECTS; however, findings remain heterogeneous and are often confounded by antiseizure medications exposure or by reliance on a single morphometric approach. Methods: We conducted a multimodal structural MRI study on 30 drug-naïve children with SeLECTS and 30 age- and sex-matched healthy controls. Voxel-based morphometry was used to quantify gray matter volume, surface-based morphometry was employed to assess cortical thickness, gyrification, and sulcal depth, and a lateralization index was used to evaluate hemispheric asymmetry. Exploratory correlation analyses were performed between these results and clinical variables as well as scores from the Wechsler Intelligence Scale for Children-Revised. Results: Patients showed increased bilateral pontine gray matter volume compared to controls. SBM identified widespread cortical thinning in frontoparietal and left temporal regions, increased gyrification in the right lateral orbitofrontal and left superior frontal gyri, and reduced right medial temporal sulcal depth. Atypical leftward lateralization was observed in the supramarginal, angular, and middle occipital gyri. Right pontine volume positively correlated with disease duration, while left superior frontal gyrification negatively correlated with verbal IQ. Conclusion: Drug-naïve children with SeLECTS exhibit a complex pattern of cortical dysmaturation and subcortical structural variations. These findings suggest that the neuroanatomical signature of SeLECTS extends beyond the Rolandic cortex, involving subcortical nuclei and widespread developmental pruning pathways. While the mechanistic links to cognition remain speculative, these structural markers provide a framework for future longitudinal studies.