SISCOM and FDG‐PET in patients with non‐lesional extratemporal epilepsy: correlation with intracranial EEG, histology, and seizure outcome

Kudr, Martin; Kršek, Pavel; Marusič, Petr; Tomášek, Martin; Trnka, Jiří; Michalová, K; Jaruskova, Monika; Šanda, Jan; Kynčl, Martin; Zámečnı́k, Josef; Rybář, Jan; Jahodová, Alena; Mohapl, M; Komárek, Vladimı́r; Tichý, Michal

doi:10.1684/epd.2013.0560

Cited by 41 publications

(26 citation statements)

References 34 publications

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“…Depending on their origin of onset among other factors, seizures may have different propagation patterns that can influence SISCOM outcome. A possible explanation is that frontal and parietal seizures may propagate faster and more easily to large areas of the brain, resulting in poorer SPECT localizations …”

Section: Discussionmentioning

confidence: 99%

Subtraction Ictal SPECT coregistered to MRI (SISCOM) as a guide in localizing childhood epilepsy

et al. 2019

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Objective To assess feasibility and efficacy of subtraction ictal SPECT coregistered to MRI (SISCOM) for epilepsy localization in children who are candidates for resective surgery. Methods We retrospectively reviewed all patients ≤16 years with drug‐resistant epilepsy screened for epilepsy surgery in the University Hospital of Leuven from January 2009 to January 2018. Fifty‐eight hospitalizations for ictal SPECT and 51 SISCOM analyses in 44 patients were included. Mean age was 9.1 years. Hospitalizations for SISCOM were analyzed in terms of multiple variables affecting feasibility and efficacy. The localization of SISCOM was compared with the localization of the presumed epileptogenic zone (PEZ) as determined by video‐EEG. Results SISCOM was feasible in terms of chronic medication management, rescue antiepileptic therapy during hospitalization, and operative timings. Radiotracer injection occurred within 30 seconds from seizure onset in 91.4% of the patients. ictal SPECT imaging was performed within two hours from injection in 100% of the patients (mean: 40 minutes). SISCOM was able to localize the PEZ in 51.0% (26/51) and to additionally lateralize the PEZ in 17.6% (9/51), achieving better localizations than ictal SPECT, FDG‐PET, and MRI (P < .01). SISCOM was useful to localize the PEZ in 25% of patients with poorly localizing video‐EEG and in 27.8% of MRI‐negative cases. The occurrence of habitual seizures during injection for ictal SPECT and the temporal localization of the PEZ both correlated with a better SISCOM localization (P < .05). 36.4% (16/44) patients were finally selected for resective surgery, with a 87.5% seizure‐free rate at 12 months. A localizing SISCOM was associated with seizure freedom in 66.7% and with a Engel I‐II in 75.0% of our patients. Significance SISCOM is a reliable tool to localize the epileptogenic zone in clinical practice and is both feasible and useful in children, adding precious presurgical information especially in patients with noninformative MRI or a poorly localizing video‐EEG.

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Section: Discussionmentioning

confidence: 99%

Subtraction Ictal SPECT coregistered to MRI (SISCOM) as a guide in localizing childhood epilepsy

et al. 2019

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“…Twenty of 23 patients were seizure-free at 4 years after a limited areas resection that showed a Taylor-type focal cortical dysplasia in all cases. Another study on 14 patients with similar clinical characteristics has shown that the complete resection of the dysplastic cortex localized by FDG-PET, SISCOM, or intracranial EEG is a reliable predictor of favorable post-operative outcome (194). Therefore, in extra-temporal lobe epilepsies, PET is best used as a guide for focusing the review of MRI in the search for subtle overlooked cortical dysplasia or to inform the placement of intracranial electrodes.…”

Section: Positron Emission Tomographymentioning

confidence: 99%

“…Nevertheless, a later study has shown an equivalent or even better yield for extra-temporal epilepsy [86% in extra-temporal compared to 67% in temporal lobe epilepsy (207)]. Some studies that included specifically patients with non-lesional extra-temporal epilepsy have shown that the resection of the SISCOM area is related to good post-operative outcome (194, 208). Similar findings have been corroborated by a prospective study (209), which has shown that if SISCOM is concordant with the future resection site, there are higher chances of having good to excellent post-operative outcome.…”

Section: Single Photon Emission Computed Tomographymentioning

confidence: 99%

The Role of Functional Neuroimaging in Pre-Surgical Epilepsy Evaluation

et al. 2014

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The prevalence of epilepsy is about 1% and one-third of cases do not respond to medical treatment. In an eligible subset of patients with drug-resistant epilepsy, surgical resection of the epileptogenic zone is the only treatment that can possibly cure the disease. Non-invasive techniques provide information for the localization of the epileptic focus in the majority of cases, whereas in others invasive procedures are required. In the last years, non-invasive neuroimaging techniques, such as simultaneous recording of functional magnetic resonance imaging and electroencephalogram (EEG-fMRI), positron emission tomography (PET), single photon emission computed tomography (SPECT), electric and magnetic source imaging (MSI, ESI), spectroscopy (MRS), have proved their usefulness in defining the epileptic focus. The combination of these functional techniques can yield complementary information and their concordance is crucial for guiding clinical decision, namely the planning of invasive EEG recordings or respective surgery. The aim of this review is to present these non-invasive neuroimaging techniques, their potential combination, and their role in the pre-surgical evaluation of patients with pharmaco-resistant epilepsy.

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“…However, the effectiveness of 3 T relative to 1.5 T MRI on improving surgical outcome remains to be assessed. In patients with nonlesional focal epilepsy, additional noninvasive diagnostic tests such as MEG, FDG‐PET, or SPECT can assist in the presurgical localization of the epileptogenic zone . The few studies that have assessed the diagnostic performance of combined functional imaging and its role on surgical decision making were conducted primarily in adults .…”

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confidence: 99%

Change in presurgical diagnostic imaging evaluation affects subsequent pediatric epilepsy surgery outcome

et al. 2015

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SUMMARYObjective: Since 2008, we have changed our presurgical diagnostic imaging evaluation for medically refractory focal epilepsy to include high-resolution epilepsy protocol on 3 T magnetic resonance imaging (MRI), and combined magnetoencephalography and 18-fluorodeoxyglucose-positron emission tomography (FDG-PET) in selected patients with normal or subtle changes on MRI or discordant diagnostic tests. The aim of this study was to evaluate the effectiveness of the change in imaging practice on epilepsy surgery outcome in a tertiary pediatric epilepsy surgery center. Methods: The change in practice occurred in early 2008, and patients were classified based on old or new practice. The patient characteristics, surgical variables, and seizure-free surgical outcome were compared, and the trend in seizure-free outcome over time was assessed. Results: There was a trend for increased abnormal MRI (92% vs. 86%, respectively, p = 0.062), and increased utilization of FDG-PET (34% vs. 3% respectively, p < 0.001) with new relative to old practice. There were no statistically significant differences in invasive monitoring, location, and type of surgery and histology between the two periods (all p > 0.05). During the old practice, there was no statistically significant change in yearly trend of seizure-free outcome (odds ratio [OR] 0.960, 95% confidence interval [CI] 0.875-1.053, p = 0.386). The change in practice in 2008 was associated with a significant improvement in seizure-free outcome (OR 1.535, 95% CI 1.100-2.142, p = 0.012). During the new practice, there was a significant positive trend in yearly seizure-free outcome (OR 1.219, 95% CI 1.053-1.411, p = 0.008), after adjusting for age at seizure onset, invasive monitoring, location and type of surgery, histology, MRI, magnetoencephalography, and FDG-PET. Significance: We have found an improvement in seizure-free surgical outcome following the change in imaging practice. This study highlights the importance of optimizing and improving presurgical diagnostic imaging evaluation to improve surgical outcome. KEY WORDS: Seizure-free outcome, Magnetic resonance imaging, 18-Fluorodeoxyglucose-positron emission tomography, Magnetoencephalography.In children with medically refractory focal epilepsy, surgery has the potential to render these patients seizure-free. Meta-analysis of pediatric epilepsy surgery outcome has shown that for combined temporal and extratemporal lobe epilepsy surgery, seizure-free outcome was 59% and for temporal lobe epilepsy surgery, seizure-free outcome was 62%. 1 We have previously shown that pediatric epilepsy surgery is a cost-effective treatment in the management of children with intractable epilepsy relative to medical therapy.2 As part of the presurgical diagnostic evaluation, the

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SISCOM and FDG‐PET in patients with non‐lesional extratemporal epilepsy: correlation with intracranial EEG, histology, and seizure outcome

Cited by 41 publications

References 34 publications

Subtraction Ictal SPECT coregistered to MRI (SISCOM) as a guide in localizing childhood epilepsy

Subtraction Ictal SPECT coregistered to MRI (SISCOM) as a guide in localizing childhood epilepsy

The Role of Functional Neuroimaging in Pre-Surgical Epilepsy Evaluation

Change in presurgical diagnostic imaging evaluation affects subsequent pediatric epilepsy surgery outcome

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