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The purpose of this study was to compare the ability to locate the EZ using SISCOM-SPM vs. However, there are only a few studies comparing SISCOM using SPM (SISCOM-SPM) vs.
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In contrast, the Statistical Parametric Mapping (SPM) is a free software that is well-documented in the literature to perform brain quantification ( 17– 19). Unfortunately, commercially available image analysis software packages for SISCOM are costly. SISCOM images have superior spatial specificity than ictal or interictal images individually and can adequately localize EZ even in patients with focal cortical dysplasia and a normal MRI ( 3, 16). Subtraction of ictal and interictal SPECT co-registered to MRI (SISCOM) has been proposed to increase the sensitivity and specificity in EZ detection ( 5, 6, 14, 15). However, sometimes visual analysis can be challenging ( 13). For extratemporal lobe epilepsies, the sensitivity for ictal SPECT is ~66% ( 11, 12). Brain SPECT can be performed during a seizure (ictal SPECT), showing increased perfusion in the EZ, and during the interictal period (interictal SPECT), showing decreased perfusion in the EZ ( 3, 5).Ī meta-analysis has shown that the sensitivity for visual localization of temporal lobe EZ is 97% on ictal SPECT and 44% on interictal SPECT ( 11). In this scenario, functional imaging methods play an essential role.īrain perfusion using single photon emission computed tomography (brain SPECT) is a nuclear medicine functional neuroimaging method able to identify regional cerebral blood flow alterations caused by the EZ ( 9, 10). Magnetic resonance imaging (MRI) is the most used imaging method to localize the epileptogenic lesion however, it cannot determine the EZ in 20–30% of temporal lobe epilepsy and in 20–40% of extratemporal epilepsy ( 8). Lesion localization requires high-resolution imaging and state-of-the-art image reconstruction software alongside neurophysiological, clinical, and seizure semiology assessments ( 7). The determination of adequate surgical candidates, as well as the precise localization of the EZ, is complex and should be carried out by a specialized multidisciplinary team to obtain the best treatment response and minimize side effects ( 3– 6). Approximately 30% of patients are refractory to medical treatment ( 2– 4), and in these cases, surgical resection of the epileptogenic zone (EZ) is the treatment of choice ( 3). It is widely distributed, affecting between 0.5 and 1% of the world population ( 2). Studies with more patients are necessary to confirm our findings.Įpilepsy is a brain disorder characterized by an ongoing tendency for recurrent epileptic seizures ( 1). SISCOM-SPM has a lower cost than other commercially available SISCOM software packages, which is an advantage for developing countries. However, this difference was not significant due to the small sample size ( p = 0.0856).Ĭonclusion: Our preliminary results demonstrate that, in clinical practice, SISCOM-SPM has the potential to add information that might help localize the EZ compared to visual analysis. Visual analysis was concordant with the EZ reference standard in only 13 patients (56.5%), while SISCOM-SPM was concordant in 18 cases (78.3%), providing a 21.8% increase in the location of EZ. We compared the location of the EZ by visual analysis of SPECT images and by SISCOM-SPM to the reference standard and classified as concordant, discordant, or partially concordant.
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We defined the reference standard to locate the EZ by pathology and follow-up (in patients submitted to surgery), or seizure semiology, serial EEG, long-term video-EEG, 18F-FDG PET/CT, and MRI (in patients who were not operated). Materials and methods: We evaluated all our patients with focal epilepsies that underwent ictal and interictal SPECT. visual analysis for localization of the EZ in patients with pharmacoresistant focal epilepsies. There are only a few studies that compare SISCOM using SPM (SISCOM-SPM) with visual analysis.Īim: To compare SISCOM-SPM vs.
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Commercially available image analysis software packages for SISCOM are costly, and Statistical Parametric Mapping (SPM) could be an alternative free software for the definition of the EZ. Introduction: Subtraction of ictal-interictal SPECT co-registered to MRI (SISCOM) is a quantification tool that can improve the sensitivity and specificity of the epileptogenic zone (EZ) localization.