Resecting critical nodes from an epileptogenic circuit in refractory focal-onset epilepsy patients using subtraction ictal SPECT coregistered to MRI.J Neurosurg 2016; 125(6):1565-1576JN
Abstract
OBJECTIVE
The purpose of this study was to assess the positive predictive value of postresection outcomes obtained by presurgical subtracted ictal SPECT in patients with lesional (MRI positive) and nonlesional (MRI negative) refractory extratemporal lobe epilepsy (ETLE) and temporal lobe epilepsy (TLE). Specifically, outcomes were compared between partial versus complete resection of the regions of transient hyperperfusion identified using subtraction ictal SPECT coregistered to MRI (SISCOM) in relation to the ictal onset zone (IOZ) that was confirmed by electrocorticography (ECoG). That is, SISCOM was used to understand the long-term postsurgical outcomes following resection of the IOZ that overlapped with 1 or more regions of ictal onset-associated transient hyperperfusion.METHODS
The study cohort included 44 consecutive patients with refractory ETLE or TLE who were treated between 2002 and 2013 and underwent presurgical evaluation using SISCOM. Concordance was determined between SISCOM localization and the IOZ on the basis of ECoG monitoring. In addition, the association between the extent of the resection site overlapping with the SISCOM signal and postresection outcomes were assessed. Postsurgical follow-up was longer than 24 months in 39 of 44 patients.RESULTS
The dominant SISCOM signals were concordant with ECoG and overlapped the resection site in 32 of 44 (73%) patients (19 ETLE and 13 TLE patients), and 20 of 32 (63%) patients became seizure free. In all 19 ETLE patients with concordant SISCOM and ECoG results, the indicated location of ictal onset on ECoG was completely resected; 11 of 19 patients (58%) became seizure free (Engel Class I). In all 13 TLE patients with concordant SISCOM and ECoG results, the indicated ECoG focus was completely resected; 9 of 13 patients (69%) became seizure free (Engel Class I). Complete resection of the SISCOM signal was found in 7 of 34 patients (21%). Of these 7 patients, 5 patients (72%) were seizure free (Engel Class I). Partial resection of the SISCOM signal was found in 16 of 34 patients (47%), and 10 of these 16 patients (63%) were seizure free (Engel Class I) after more than 24 months of follow-up.CONCLUSIONS
Concordance between 1 or more SISCOM regions of hyperperfusion with ECoG and at least partial resection of the dominant SISCOM signal in this refractory epilepsy cohort provided additional useful information for predicting long-term postresection outcomes. Such regions are likely critical nodes in more extensive, active, epileptogenic circuits. In addition, SPECT scanner technology may limit the sensitivity of meaningful SISCOM signals for identifying the maximal extent of the localizable epileptogenic network.Links
MeSH
Pub Type(s)
Journal Article
Language
eng
PubMed ID
26991384
Citation
Jalota, Abhijay, et al. "Resecting Critical Nodes From an Epileptogenic Circuit in Refractory Focal-onset Epilepsy Patients Using Subtraction Ictal SPECT Coregistered to MRI." Journal of Neurosurgery, vol. 125, no. 6, 2016, pp. 1565-1576.
Jalota A, Rossi MA, Pylypyuk V, et al. Resecting critical nodes from an epileptogenic circuit in refractory focal-onset epilepsy patients using subtraction ictal SPECT coregistered to MRI. J Neurosurg. 2016;125(6):1565-1576.
Jalota, A., Rossi, M. A., Pylypyuk, V., Stein, M., Stoub, T., Balabanov, A., ... Byrne, R. (2016). Resecting critical nodes from an epileptogenic circuit in refractory focal-onset epilepsy patients using subtraction ictal SPECT coregistered to MRI. Journal of Neurosurgery, 125(6), pp. 1565-1576.
Jalota A, et al. Resecting Critical Nodes From an Epileptogenic Circuit in Refractory Focal-onset Epilepsy Patients Using Subtraction Ictal SPECT Coregistered to MRI. J Neurosurg. 2016;125(6):1565-1576. PubMed PMID: 26991384.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR
T1 - Resecting critical nodes from an epileptogenic circuit in refractory focal-onset epilepsy patients using subtraction ictal SPECT coregistered to MRI.
AU - Jalota,Abhijay,
AU - Rossi,Marvin A,
AU - Pylypyuk,Volodymyr,
AU - Stein,Michael,
AU - Stoub,Travis,
AU - Balabanov,Antoaneta,
AU - Bergen,Donna,
AU - Bermeo,Adriana,
AU - Park,Esmeralda,
AU - Smith,Michael,
AU - Byrne,Richard,
Y1 - 2016/03/18/
PY - 2016/3/19/pubmed
PY - 2018/8/3/medline
PY - 2016/3/19/entrez
KW - AED = antiepileptic drug
KW - ECoG = chronic electrocorticography
KW - EEG = electroencephalography
KW - ETLE = extratemporal epilepsy
KW - IOZ = ictal onset zone
KW - SISCOM = subtraction ictal SPECT coregistered to MRI
KW - SPGR = spoiled gradient recalled
KW - TLE = temporal lobe epilepsy
KW - aECoG = acute electrocorticography
KW - electrocorticography
KW - epileptogenic network
KW - extratemporal epilepsy
KW - ictal onset zone
KW - magnetic resonance imaging
KW - subtraction ictal SPECT coregistered to MRI
KW - temporal lobe epilepsy
SP - 1565
EP - 1576
JF - Journal of neurosurgery
JO - J. Neurosurg.
VL - 125
IS - 6
N2 - OBJECTIVE The purpose of this study was to assess the positive predictive value of postresection outcomes obtained by presurgical subtracted ictal SPECT in patients with lesional (MRI positive) and nonlesional (MRI negative) refractory extratemporal lobe epilepsy (ETLE) and temporal lobe epilepsy (TLE). Specifically, outcomes were compared between partial versus complete resection of the regions of transient hyperperfusion identified using subtraction ictal SPECT coregistered to MRI (SISCOM) in relation to the ictal onset zone (IOZ) that was confirmed by electrocorticography (ECoG). That is, SISCOM was used to understand the long-term postsurgical outcomes following resection of the IOZ that overlapped with 1 or more regions of ictal onset-associated transient hyperperfusion. METHODS The study cohort included 44 consecutive patients with refractory ETLE or TLE who were treated between 2002 and 2013 and underwent presurgical evaluation using SISCOM. Concordance was determined between SISCOM localization and the IOZ on the basis of ECoG monitoring. In addition, the association between the extent of the resection site overlapping with the SISCOM signal and postresection outcomes were assessed. Postsurgical follow-up was longer than 24 months in 39 of 44 patients. RESULTS The dominant SISCOM signals were concordant with ECoG and overlapped the resection site in 32 of 44 (73%) patients (19 ETLE and 13 TLE patients), and 20 of 32 (63%) patients became seizure free. In all 19 ETLE patients with concordant SISCOM and ECoG results, the indicated location of ictal onset on ECoG was completely resected; 11 of 19 patients (58%) became seizure free (Engel Class I). In all 13 TLE patients with concordant SISCOM and ECoG results, the indicated ECoG focus was completely resected; 9 of 13 patients (69%) became seizure free (Engel Class I). Complete resection of the SISCOM signal was found in 7 of 34 patients (21%). Of these 7 patients, 5 patients (72%) were seizure free (Engel Class I). Partial resection of the SISCOM signal was found in 16 of 34 patients (47%), and 10 of these 16 patients (63%) were seizure free (Engel Class I) after more than 24 months of follow-up. CONCLUSIONS Concordance between 1 or more SISCOM regions of hyperperfusion with ECoG and at least partial resection of the dominant SISCOM signal in this refractory epilepsy cohort provided additional useful information for predicting long-term postresection outcomes. Such regions are likely critical nodes in more extensive, active, epileptogenic circuits. In addition, SPECT scanner technology may limit the sensitivity of meaningful SISCOM signals for identifying the maximal extent of the localizable epileptogenic network.
SN - 1933-0693
UR - https://www.unboundmedicine.com/medline/citation/26991384/Resecting_critical_nodes_from_an_epileptogenic_circuit_in_refractory_focal_onset_epilepsy_patients_using_subtraction_ictal_SPECT_coregistered_to_MRI_
L2 - https://thejns.org/doi/10.3171/2015.6.JNS141719
DB - PRIME
DP - Unbound Medicine
ER -