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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.

Authors+Show Affiliations

Rush Epilepsy Center, Department of Neurological Sciences.Rush Epilepsy Center, Department of Neurological Sciences. Department of Diagnostic Radiology and Nuclear Medicine; and.Department of Diagnostic Radiology and Nuclear Medicine; and.Rush Epilepsy Center, Department of Neurological Sciences.Rush Epilepsy Center, Department of Neurological Sciences.Rush Epilepsy Center, Department of Neurological Sciences.Rush Epilepsy Center, Department of Neurological Sciences.Rush Epilepsy Center, Department of Neurological Sciences.Rush Epilepsy Center, Department of Neurological Sciences.Rush Epilepsy Center, Department of Neurological Sciences.Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.

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 -