The effect of injection time on rates of epileptogenic zone localization using SISCOM and STATISCOM

Hlauschek, Gernot; Sinclair, Benjamin; Brinkmann, Benjamin H.; Fuge, Joshua; Kwan, Patrick; O’Brien, Terence J.; Vivash, Lucy

doi:10.1016/j.yebeh.2021.107945

Cited by 7 publications

(11 citation statements)

References 18 publications

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“…Regarding seizure injection latencies, previous work showed inconsistent results. Whereas in some studies, short seizure injection latencies correlated with better VSA and ISAS outcomes, 16,28 other reports, including our current study, found no association between longer seizure injection latencies and poor VSA and ISAS outcomes 18,29 . This may detract from the dogma of immediate injection in ictal SPECT but is more likely due to the small number of cases with prolonged infusion latencies (>45 seconds) in our patient population.…”

Section: Discussioncontrasting

confidence: 82%

“…Whereas in some studies, short seizure injection latencies correlated with better VSA and ISAS outcomes, 16,28 other reports, including our current study, found no association between longer seizure injection latencies and poor VSA and ISAS outcomes. 18,29 This may detract from the dogma of immediate injection in ictal SPECT but is more likely due to the small number of cases with prolonged infusion latencies (>45 seconds) in our patient population. In the general comparison, VSA and ISAS outperformed EEG in its ability to localize the SOZ but are less sensitive than MRI based on conventional radiological readings.…”

Section: Discussionmentioning

confidence: 93%

“…Additionally, the localization precision is improved by mapping the results to the structural MRI image of the subject. 5 , 6 , 17 , 18 Most SPECT studies focus on the concordance of SPECT results and the resected focus in a small cohort of operated individuals, 19 , 20 , 21 , 22 but only few studies have compared VSA and ISAS in a large, unselected cohort.…”

Section: Introductionmentioning

confidence: 99%

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The diagnostic value of ictal SPECT—A retrospective, semiquantitative monocenter study

et al. 2023

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Objective: Ictal single photon emission computed tomography (SPECT) can be used as an advanced diagnostic modality to detect the seizure onset zone in the presurgical evaluation of people with epilepsy. In addition to visual assessment (VSA) of ictal and interictal SPECT images, postprocessing methods such as ictal-interictal SPECT analysis using SPM (ISAS) can visualize regional ictal blood flow differences. We aimed to evaluate and differentiate the diagnostic value of VSA and ISAS in the Bonn cohort. Methods:We included 161 people with epilepsy who underwent presurgical evaluation at the University Hospital Bonn between 2008 and 2020 and received ictal and interictal SPECT and ISAS. We retrospectively assigned SPECT findings to one of five categories according to their degree of concordance with the clinical focus hypothesis.Results: Seizure onset zones could be identified more likely on a sublobar concordance level by ISAS than by VSA (31% vs. 19% of cases; OR = 1.88; 95% Cl [1.04, 3.42]; P = 0.03). Both VSA and ISAS more often localized a temporal seizure onset zone than an extratemporal one. Neither VSA nor ISAS findings were

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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The diagnostic value of ictal SPECT—A retrospective, semiquantitative monocenter study

et al. 2023

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“…64 The use of statistical ictal SPECT coregistered to MRI (STATISCOM) may reduce dependence on low-latency injection. 65 Localizing patterns on ictal SPECT are associated with a higher likelihood of postsurgical seizure freedom in patients with nonlesional MRI, 40 particularly when concordant with other localization modalities (such as FDG-PET, magnetoencephalography [MEG], and MRI). 37 Magnetoencephalography MEG detects magnetic fields that are generated perpendicularly to the electric fields of synchronized neuronal activity.…”

Section: Single-photon Emission Computed Tomographymentioning

confidence: 99%

The Noninvasive Evaluation for Minimally Invasive Pediatric Epilepsy Surgery (MIPES): A Multimodal Exploration of the Localization-Based Hypothesis

Mohanty

Quach

2022

Journal of Pediatric Epilepsy

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Minimally invasive pediatric epilepsy surgery (MIPES) is a rising technique in the management of focal-onset drug-refractory epilepsy. Minimally invasive surgical techniques are based on small, focal interventions (such as parenchymal ablation or localized neuromodulation) leading to elimination of the seizure onset zone or interruption of the larger epileptic network. Precise localization of the seizure onset zone, demarcation of eloquent cortex, and mapping of the network leading to seizure propagation are required to achieve optimal outcomes. The toolbox for presurgical, noninvasive evaluation of focal epilepsy continues to expand rapidly, with a variety of options based on advanced imaging and electrophysiology. In this article, we will examine several of these diagnostic modalities from the standpoint of MIPES and discuss how each can contribute to the development of a localization-based hypothesis for potential surgical targets.

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“…This may be particularly true if tracer injection is delayed to a point when seizure activity has spread far beyond the ONZ. 5 It is also important to recognize that hyperperfusion is common in subcortical regions such as basal ganglia, 6 and some contralateral activations are not uncommon and have been described in insular 7 and mesial temporal lobe epilepsy. 8 Therefore, integration of SISCOM results with other clinical, electrophysiological, and imaging findings remains critical in surgical planning.…”

Section: Commentarymentioning

confidence: 99%

Of Blobs and Buzzes: Does SISCOM Imaging Actually Help SEEG Planning?

Englot

Lagrange

2021

Epilepsy Curr

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Perfusion patterns observed in Subtraction Ictal SPECT Co-registered to MRI (SISCOM) assist in focus localization and surgical planning for patients with medically intractable focal epilepsy. While the localizing value of SISCOM has been widely investigated, its relationship to the underlying electrophysiology has not been extensively studied and is therefore not well understood. In the present study, we set to investigate this relationship in a cohort of 70 consecutive patients who underwent ictal and interictal SPECT studies and subsequent stereo-electroencephalography (SEEG) monitoring for localization of the epileptogenic focus and surgical intervention. Seizures recorded during SEEG evaluation (SEEG seizures) were matched to semiologically-similar seizures during the preoperative ictal SPECT evaluation (SPECT seizures) by comparing the semiological changes in the course of each seizure. The spectral changes of the ictal SEEG with respect to interictal ones over 7 traditional frequency bands (0.1 to 150 Hz) were analyzed at each SEEG site. Neurovascular (SEEG/SPECT) relations were assessed by comparing the estimated spectral power density changes of the SEEG at each site with the perfusion changes (SISCOM z-scores) estimated from the acquired SISCOM map at that site. Across patients, a significant correlation (P < 0.05) was observed between spectral changes during the SEEG seizure and SISCOM perfusion z-scores. Brain sites with high perfusion z-score exhibited higher increased SEEG power in theta to ripple frequency bands with concurrent suppression in delta and theta frequency bands compared to regions with lower perfusion z-score. The dynamics of the correlation of SISCOM perfusion and SEEG spectral power from ictal onset to seizure end and immediate postictal period were also derived. Forty-six (46) of the 70 patients underwent resective epilepsy surgery. SISCOM z-score and power increase in beta to ripple frequency bands were significantly higher in resected than non-resected sites in the patients who were seizure-free following surgery. This study provides for the first time concrete evidence that both hyper-perfusion and hypo-perfusion patterns observed in SISCOM maps have strong electrophysiological underpinnings, and that integration of the information from SISCOM and SEEG can shed light on the location and dynamics of the underlying epileptic brain networks, and thus advance our anatomo-electro-clinical understanding and approaches to targeted diagnostic and therapeutic interventions.

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The effect of injection time on rates of epileptogenic zone localization using SISCOM and STATISCOM

Cited by 7 publications

References 18 publications

The diagnostic value of ictal SPECT—A retrospective, semiquantitative monocenter study

The diagnostic value of ictal SPECT—A retrospective, semiquantitative monocenter study

The Noninvasive Evaluation for Minimally Invasive Pediatric Epilepsy Surgery (MIPES): A Multimodal Exploration of the Localization-Based Hypothesis

Of Blobs and Buzzes: Does SISCOM Imaging Actually Help SEEG Planning?

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