Tags

Type your tag names separated by a space and hit enter

Ictal SPECT statistical parametric mapping in temporal lobe epilepsy surgery.
Neurology 2010; 74(1):70-6Neur

Abstract

OBJECTIVE

Although subtraction ictal SPECT coregistered to MRI (SISCOM) is clinically useful in epilepsy surgery evaluation, it does not determine whether the ictal-interictal subtraction difference is statistically different from the expected random variation between 2 SPECT studies. We developed a statistical parametric mapping and MRI voxel-based method of analyzing ictal-interictal SPECT difference data (statistical ictal SPECT coregistered to MRI [STATISCOM]) and compared it with SISCOM.

METHODS

Two serial SPECT studies were performed in 11 healthy volunteers without epilepsy (control subjects) to measure random variation between serial studies from individuals. STATISCOM and SISCOM images from 87 consecutive patients who had ictal SPECT studies and subsequent temporal lobectomy were assessed by reviewers blinded to clinical data and outcome.

RESULTS

Interobserver agreement between blinded reviewers was higher for STATISCOM images than for SISCOM images (kappa = 0.81 vs kappa = 0.36). STATISCOM identified a hyperperfusion focus in 84% of patients, SISCOM in 66% (p < 0.05). STATISCOM correctly localized the temporal lobe epilepsy (TLE) subtypes (mesial vs lateral neocortical) in 68% of patients compared with 24% by SISCOM (p = 0.02); subgroup analysis of patients without lesions (as determined by MRI) showed superiority of STATISCOM (80% vs 47%; p = 0.04). Moreover, the probability of seizure-free outcome was higher when STATISCOM correctly localized the TLE subtype than when it was indeterminate (81% vs 53%; p = 0.03).

CONCLUSION

Statistical ictal SPECT coregistered to MRI (STATISCOM) was superior to subtraction ictal SPECT coregistered to MRI for seizure localization before temporal lobe epilepsy (TLE) surgery. STATISCOM localization to the correct TLE subtype was prognostically important for postsurgical seizure freedom.

Authors+Show Affiliations

Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

20038775

Citation

Kazemi, N J., et al. "Ictal SPECT Statistical Parametric Mapping in Temporal Lobe Epilepsy Surgery." Neurology, vol. 74, no. 1, 2010, pp. 70-6.
Kazemi NJ, Worrell GA, Stead SM, et al. Ictal SPECT statistical parametric mapping in temporal lobe epilepsy surgery. Neurology. 2010;74(1):70-6.
Kazemi, N. J., Worrell, G. A., Stead, S. M., Brinkmann, B. H., Mullan, B. P., O'Brien, T. J., & So, E. L. (2010). Ictal SPECT statistical parametric mapping in temporal lobe epilepsy surgery. Neurology, 74(1), pp. 70-6. doi:10.1212/WNL.0b013e3181c7da20.
Kazemi NJ, et al. Ictal SPECT Statistical Parametric Mapping in Temporal Lobe Epilepsy Surgery. Neurology. 2010 Jan 5;74(1):70-6. PubMed PMID: 20038775.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ictal SPECT statistical parametric mapping in temporal lobe epilepsy surgery. AU - Kazemi,N J, AU - Worrell,G A, AU - Stead,S M, AU - Brinkmann,B H, AU - Mullan,B P, AU - O'Brien,T J, AU - So,E L, PY - 2009/12/30/entrez PY - 2009/12/30/pubmed PY - 2010/1/16/medline SP - 70 EP - 6 JF - Neurology JO - Neurology VL - 74 IS - 1 N2 - OBJECTIVE: Although subtraction ictal SPECT coregistered to MRI (SISCOM) is clinically useful in epilepsy surgery evaluation, it does not determine whether the ictal-interictal subtraction difference is statistically different from the expected random variation between 2 SPECT studies. We developed a statistical parametric mapping and MRI voxel-based method of analyzing ictal-interictal SPECT difference data (statistical ictal SPECT coregistered to MRI [STATISCOM]) and compared it with SISCOM. METHODS: Two serial SPECT studies were performed in 11 healthy volunteers without epilepsy (control subjects) to measure random variation between serial studies from individuals. STATISCOM and SISCOM images from 87 consecutive patients who had ictal SPECT studies and subsequent temporal lobectomy were assessed by reviewers blinded to clinical data and outcome. RESULTS: Interobserver agreement between blinded reviewers was higher for STATISCOM images than for SISCOM images (kappa = 0.81 vs kappa = 0.36). STATISCOM identified a hyperperfusion focus in 84% of patients, SISCOM in 66% (p < 0.05). STATISCOM correctly localized the temporal lobe epilepsy (TLE) subtypes (mesial vs lateral neocortical) in 68% of patients compared with 24% by SISCOM (p = 0.02); subgroup analysis of patients without lesions (as determined by MRI) showed superiority of STATISCOM (80% vs 47%; p = 0.04). Moreover, the probability of seizure-free outcome was higher when STATISCOM correctly localized the TLE subtype than when it was indeterminate (81% vs 53%; p = 0.03). CONCLUSION: Statistical ictal SPECT coregistered to MRI (STATISCOM) was superior to subtraction ictal SPECT coregistered to MRI for seizure localization before temporal lobe epilepsy (TLE) surgery. STATISCOM localization to the correct TLE subtype was prognostically important for postsurgical seizure freedom. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/20038775/Ictal_SPECT_statistical_parametric_mapping_in_temporal_lobe_epilepsy_surgery_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&amp;pmid=20038775 DB - PRIME DP - Unbound Medicine ER -