Automated detection of focal cortical dysplasia in epilepsy using machine learning on structural MRI

Abstract Focal cortical dysplasia (FCD) represents a structural brain anomaly of developmental origin that significantly contributes to epilepsy. This proof-of-concept study evaluates the feasibility of machine learning (ML) algorithms to distinguish patients with FCD type II-associated epilepsy from healthy controls (HCs) using high-resolution structural MRI. Structural MRI data from a publicly available dataset comprising 167 subjects (both FCD-associated epilepsy patients and HCs) were analyzed. Neuroanatomical features were extracted with FreeSurfer software. Preprocessing steps included dataset reconstruction, feature scaling, dimensionality reduction, and encoding of demographic variables. Multiple supervised ML models—including Logistic Regression, Support Vector Machine, Gradient Boosting, and Random Forest—were trained and evaluated using nested cross-validation with 10 outer folds and 5 inner folds. Among the evaluated classifiers, Random Forest achieved the highest AUC (0.791). This model demonstrated balanced classification ability, as reflected by its ROC and Precision-Recall curves. While promising, these results reflect the model’s performance on the current dataset and require further validation. This study demonstrates the preliminary potential of ML techniques to distinguish FCD-associated epilepsy from HCs using structural MRI, providing supportive information for clinical review. However, further studies with larger, independent clinical cohorts are necessary to validate these results before considering any clinical implementation.