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Prener M, Drejer V, Ziebell M, Jensen P, Madsen CG, Olsen S, Thomsen G, Pinborg LH, Paulson OB. Ictal and interictal SPECT with 99m Tc-HMPAO in presurgical epilepsy. II: Methodological considerations on hyper- and hypoperfusion. Epilepsia Open 2023; 8:1503-1511. [PMID: 37750050 PMCID: PMC10690685 DOI: 10.1002/epi4.12833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Single-photon emission computed tomography (SPECT) with the tracer 99m Tc-HMPAO is a method to visualize the cerebral hyperperfusion during an epileptic seizure and thus localize the epileptogenic zone and seizure propagation. Subtraction of interictal from Ictal SPECT Co-registered to MRI (SISCOM) visualizes areas with relative increases in cerebral blood flow. The purpose of this retrospective study is to explore the added value of visualizing areas of hypoperfusion as well as hyperperfusion, so-called reversed SISCOM. METHODS Fifty-six patients operated for epilepsy who had been investigated with SISCOM were included in the analysis. The patients were divided into two groups based on seizure duration after tracer injection, above or below 30 s. The preoperative SISCOM description was compared to the area of resection and given a concordance score. The 56 SISCOM were recalculated visualizing also areas of hypoperfusion and again compared to the site of resection using the same scale of concordance. The reversed SISCOM were categorized into three subgroups: "Altered Conclusion," "Confirmed Conclusion," and "Adds Nothing." If an area of hyperperfusion had an area of hypoperfusion in close proximity, it was re-interpreted as noise, thus possibly altering the conclusion. If the areas of hypoperfusion were in the opposite hemisphere it was interpreted as confirming factor. Further the concordance scores from conventional SISCOM and reversed SISCOM was compared to surgical outcome to explore the difference in sensitivity, positive predictive value (PPV), and odds ratio. RESULTS In approximately half of the cases reversed SISCOM added additional value, meaning either altered the conclusion or confirmed the conclusion. The sensitivity, PPV, and odds ratio was also better in the subgroup of long, >30 s seizure duration after injection, and got worse in the group with short, <30 s seizure duration after injection. SIGNIFICANCE Adding reversed SISCOM performed better than conventional SISCOM at predicting good surgical outcome.
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Affiliation(s)
- Martin Prener
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Veronica Drejer
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Morten Ziebell
- Department of NeurosurgeryRigshospitaletCopenhagenDenmark
| | - Per Jensen
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Camilla Gøbel Madsen
- Department of Radiology, Centre for Functional and Diagnostic imaging and ResearchCopenhagen University Hospital Amager and HvidovreHvidovreDenmark
| | - Svitlana Olsen
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Gerda Thomsen
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
| | - Lars H. Pinborg
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
- Epilepsy Clinic, Department of Neurology, Rigshospitalet, Copenhagen, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Olaf B. Paulson
- Neurobiology Research Unit, Department of NeurologyRigshospitalet BlegdamsvejCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
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Aungaroon G, Trout AT, Radhakrishnan R, Horn PS, Arya R, Tenney JR, Holland KD, Mangano FT, Leach JL, Rozhkov L, Greiner HM. Subtraction ictal SPECT co-registered to MRI (SISCOM) patterns in children with temporal lobe epilepsy. Epilepsy Behav 2021; 121:108074. [PMID: 34062446 DOI: 10.1016/j.yebeh.2021.108074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/12/2021] [Accepted: 05/12/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We evaluated SISCOM patterns and their relationship with surgical outcome in children with temporal lobe epilepsy (TLE) who had undergone a temporal lobe surgery. METHODS This was an observational study evaluating SISCOM patterns in 40 children with TLE. We classified SISCOM patterns into 4 categories; (i) unilateral anteromesial and/or anterolateral temporal pattern; (ii) unilateral anteromesial and/or anterolateral temporal plus posterior extension pattern; (iii) bilateral anteromesial and/or anterolateral temporal pattern; and (iv) atypical pattern. Determinants of SISCOM pattern and correlation between postoperative outcomes and SISCOM patterns were evaluated. RESULTS Pattern (i), (ii), (iii), and (iv) were identified in 10 (25%), 14 (35%), 0 (0%), and 16 (40%) patients, respectively. There was no significant correlation between patterns and postoperative outcomes. SISCOM patterns significantly associated with the presence of hippocampal sclerosis and type of focal cortical dysplasia (p-value = 0.048 and 0.036, respectively). Patients with HS had 5 times the odds of having unilateral temporal pattern, compared to patients with other neuropathology (OR = 5, 95% CI 0.92 to 27.08). Patients with FCD type 2 had 9.71 times the odds of having atypical pattern, compared to patients with other types of FCD (OR = 9.71, 95% CI 0.92 to 103.04). Lobar concordance of SISCOM and ictal and interictal scalp EEG significantly correlated with postoperative outcomes (p-value = 0.018 and 0.013, respectively). CONCLUSION Three SISCOM patterns were seen. Patients with HS had increased odds of having unilateral temporal pattern while patients with FCD type 2 had increased odds of having atypical pattern. However, there was no significant correlation between SISCOM patterns and postoperative outcomes. Lobar concordance of SISCOM and ictal and interictal scalp EEG significantly correlated with postoperative outcome. SIGNIFICANCE This study shows that the distribution of SISCOM patterns and their relationship with postoperative outcomes in children with TLE are different from adult population. Besides, SISCOM may add only limited diagnostic and prognostic information in children with drug-resistant TLE undergoing epilepsy surgery. Further evaluation to identify patient populations that may benefit from SISCOM is desirable.
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Affiliation(s)
- Gewalin Aungaroon
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Andrew T Trout
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rupa Radhakrishnan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Paul S Horn
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffrey R Tenney
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katherine D Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James L Leach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Leonid Rozhkov
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hansel M Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Englot DJ, Lagrange AH. Of Blobs and Buzzes: Does SISCOM Imaging Actually Help SEEG Planning? Epilepsy Curr 2021; 22:22-24. [PMID: 35233191 PMCID: PMC8832343 DOI: 10.1177/15357597211025408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Surgical outcome and prognostic factors in epilepsy patients with MR-negative focal cortical dysplasia. PLoS One 2021; 16:e0249929. [PMID: 33852634 PMCID: PMC8046256 DOI: 10.1371/journal.pone.0249929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 03/26/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Focal cortical dysplasia (FCD) represents a heterogeneous group of disorders of the cortical formation and is one of the most common causes of epilepsy. Magnetic resonance imaging (MRI) is the modality of choice for detecting structural lesions, and the surgical prognosis in patients with MR lesions is favorable. However, the surgical prognosis of patients with MR-negative FCD is unknown. We aimed to evaluate the long-term surgical outcomes and prognostic factors in MR-negative FCD patients through comprehensive presurgical data. Methods We retrospectively reviewed data from 719 drug-resistant epilepsy patients who underwent resective surgery and selected cases in which surgical specimens were pathologically confirmed as FCD Type I or II. If the epileptogenic focus and surgical specimens were obtained from brain areas with a normal MRI appearance, they were classified as MR-negative FCD. Surgical outcomes were evaluated at 2 and 5 years, and clinical, neurophysiological, and neuroimaging data of MR-negative FCD were compared to those of MR-positive FCD. Results Finally, 47 MR-negative and 34 MR-positive FCD patients were enrolled in the study. The seizure-free rate after surgery (Engel classification I) at postoperative 2 year was 59.5% and 64.7% in the MR-negative and positive FCD groups, respectively (p = 0.81). This rate decreased to 57.5% and 44.4% in the MR-negative and positive FCD groups (p = 0.43) at postoperative 5 years. MR-negative FCD showed a higher proportion of FCD type I (87.2% vs. 50.0%, p = 0.001) than MR-positive FCD. Unilobar cerebral perfusion distribution (odds ratio, OR 5.41) and concordance of interictal epileptiform discharges (OR 5.10) were significantly associated with good surgical outcomes in MR-negative FCD. Conclusion In this study, MR-negative and positive FCD patients had a comparable surgical prognosis, suggesting that comprehensive presurgical evaluations, including multimodal neuroimaging studies, are crucial for obtaining excellent surgical outcomes even in epilepsy patients with MR-negative FCD.
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Tsougos I, Kousi E, Georgoulias P, Kapsalaki E, Fountas KN. Neuroimaging methods in Epilepsy of Temporal Origin. Curr Med Imaging 2018; 15:39-51. [DOI: 10.2174/1573405613666170622114920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/04/2017] [Accepted: 05/11/2017] [Indexed: 11/22/2022]
Abstract
Background:
Temporal Lobe Epilepsy (TLE) comprises the most common form of
symptomatic refractory focal epilepsy in adults. Accurate lateralization and localization of the
epileptogenic focus are a significant prerequisite for determining surgical candidacy once the
patient has been deemed medically intractable. Structural MR imaging, clinical,
electrophysiological, and neurophysiological data have an established role in the localization of the
epileptogenic foci. Nevertheless, hippocampal sclerosis cannot be detected on MR images in more
than 30% of patients with TLE, and the presurgical assessment remains controversial.
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Discussion: In the last years, advanced MR imaging techniques, such as 1H-MRS, DWI, DTI,
DSCI, and fMRI, may provide valuable additional information regarding the physiological and
metabolic characterization of brain tissue. MR imaging has shifted towards functional and
molecular imaging, thus, promising to improve the accuracy regarding the lateralization and the
localization of the epileptogenic focus. Additionally, nuclear medicine studies, such as SPECT and
PET imaging modalities, have become an asset for the decoding of brain function and activity, and
can be diagnostically helpful as well, since they provide valuable data regarding the altered
metabolic activity of the seizure foci.
Conclusion:
Overall, advanced MRI, SPECT, and PET imaging techniques are increasingly
becoming an essential part of TLE diagnostics, when the epileptogenic area is not identified on
structural MRI or when structural MRI, clinical, and electrophysiological findings are not in
concordance.
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Affiliation(s)
- Ioannis Tsougos
- Department of Medical Physics, School of Medicine, University of Thessaly, Larisa, Greece
| | - Evanthia Kousi
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Panagiotis Georgoulias
- Department of Medical Physics, School of Medicine, University of Thessaly, Larisa, Greece
| | - Eftychia Kapsalaki
- Department of Medical Physics, School of Medicine, University of Thessaly, Larisa, Greece
| | - Kostas N. Fountas
- Department of Medical Physics, School of Medicine, University of Thessaly, Larisa, Greece
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Prognostic factors determining poor postsurgical outcomes of mesial temporal lobe epilepsy. PLoS One 2018; 13:e0206095. [PMID: 30339697 PMCID: PMC6195284 DOI: 10.1371/journal.pone.0206095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/06/2018] [Indexed: 01/12/2023] Open
Abstract
Objectives To investigate the long-term postoperative outcomes and predictive factors associated with poor surgical outcomes in mesial temporal lobe epilepsy (MTLE). Materials and methods We enrolled patients with MTLE who underwent resective surgery at single university-affiliated hospital. Surgical outcomes were determined using a modified Engel classification at the 2nd and 5th years after surgery and the last time of follow-up. Results The mean duration of follow-up after surgery was 7.6 ± 3.7 years (range, 5.0–21.0 years). 334 of 400 patients (83.5%) were seizure-free at the 5th postoperative year. Significant predictive factors of a poor outcome at the 5th year were a history of generalized tonic clonic (GTC) seizures (odds ratio, OR; 2.318), bi-temporal interictal epileptiform discharge (IED) (OR; 3.107), bilateral hippocampal sclerosis (HS) (OR; 5.471), unilateral HS and combined extra-hippocampal lesion (OR; 5.029), and bi-temporal hypometabolism (BTH) (OR; 4.438). Bi-temporal IED (hazard ratio, HR; 2.186), BTH (HR; 2.043), bilateral HS (HR; 2.541) and unilateral HS and combined extra-hippocampal lesion (HR; 2.75) were independently associated with seizure recurrence. We performed a subgroup analysis of 208 patients with unilateral HS, and their independent predictors of a poor outcome at the 5th year were BTH (OR; 5.838) and tailored hippocampal resection (OR; 11.053). Conclusion This study demonstrates that 16.5% of MTLE patients had poor long-term outcomes after surgery. Bilateral involvement in electrophysiological and imaging studies predicts poor surgical outcomes in MTLE patients.
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Lesional cerebellar epilepsy: a review of the evidence. J Neurol 2016; 264:1-10. [PMID: 27260293 DOI: 10.1007/s00415-016-8161-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
Classical teaching in epileptology localizes the origins of focal seizures solely in the cerebral cortex, with only inhibitory effects attributed to subcortical structures. However, electrophysiological and neuroimaging studies over the last decades now provide evidence for an initiation of epileptic seizures within subcortical structures. Intrinsic epileptogenicity of hypothalamic hamartoma has already been established in recognition of subcortical epilepsy, whereas a seizure-generating impact of dysplastic cerebellar lesions remains to be clarified. Herein, we examine the supportive evidence and clinical presentation of cerebellar seizures and review therapy options.
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Abstract
Single-photon emission computed tomography (SPECT) is a functional nuclear imaging technique that allows visualization and quantification of different in vivo physiologic and pathologic features of brain neurobiology. It has been used for many years in diagnosis of several neurologic and psychiatric disorders. In this chapter, we discuss the current state-of-the-art of SPECT imaging of brain perfusion and dopamine transporter (DAT) imaging. Brain perfusion SPECT imaging plays an important role in the localization of the seizure onset zone in patients with refractory epilepsy. In cerebrovascular disease, it can be useful in determining the cerebrovascular reserve. After traumatic brain injury, SPECT has shown perfusion abnormalities despite normal morphology. In the context of organ donation, the diagnosis of brain death can be made with high accuracy. In neurodegeneration, while amyloid or (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) are the nuclear diagnostic tools of preference for early and differential diagnosis of dementia, perfusion SPECT imaging can be useful, albeit with slightly lower accuracy. SPECT imaging of the dopamine transporter system is widely available in Europe and Asia, but since recently also in the USA, and has been accepted as an important diagnostic tool in the early and differential diagnosis of parkinsonism in patients with unclear clinical features. The combination of perfusion SPECT (or FDG-PET) and DAT imaging provides differential diagnosis between idiopathic Parkinson's disease, Parkinson-plus syndromes, dementia with Lewy bodies, and essential tremor.
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Affiliation(s)
- Karolien Goffin
- Division of Nuclear Medicine, University Hospital Leuven and KU Leuven, Leuven, Belgium
| | - Koen van Laere
- Division of Nuclear Medicine, University Hospital Leuven and KU Leuven, Leuven, Belgium.
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Elwan SA, Wu G, Huang SSL, Najm IM, So NK. Ictal single photon emission computed tomography in epileptic auras. Epilepsia 2013; 55:133-6. [DOI: 10.1111/epi.12475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Sherif A. Elwan
- Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
- Department of Neurology; Ain Shams University; Cairo Egypt
| | - Guiyun Wu
- Department of Nuclear Medicine; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Steve S. L. Huang
- Department of Nuclear Medicine; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Imad M. Najm
- Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
| | - Norman K. So
- Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland Ohio U.S.A
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Yuan C, Zhang Z, Wang Z, Liao W, Chen G, Northoff G, Lu G. Impaired self-referential processing in mesial temporal lobe epilepsy: A functional MRI study. Neurosci Lett 2013; 555:187-92. [DOI: 10.1016/j.neulet.2013.09.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/13/2013] [Accepted: 09/23/2013] [Indexed: 11/27/2022]
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Schneider F, Irene Wang Z, Alexopoulos AV, Almubarak S, Kakisaka Y, Jin K, Nair D, Mosher JC, Najm IM, Burgess RC. Magnetic source imaging and ictal SPECT in MRI-negative neocortical epilepsies: Additional value and comparison with intracranial EEG. Epilepsia 2012; 54:359-69. [DOI: 10.1111/epi.12004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schwartz TH, Hong SB, Bagshaw AP, Chauvel P, Bénar CG. Preictal changes in cerebral haemodynamics: review of findings and insights from intracerebral EEG. Epilepsy Res 2011; 97:252-66. [PMID: 21855297 DOI: 10.1016/j.eplepsyres.2011.07.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 06/29/2011] [Accepted: 07/27/2011] [Indexed: 12/29/2022]
Abstract
The possibility of recording changes in brain signals occurring before epileptic seizures is of considerable interest, both as markers for seizure anticipation and as a window into the mechanisms of seizure generation. Several studies have reported preictal changes on electrophysiological traces. More recently, observations have been made of changes occurring on haemodynamic signals before interictal events or before seizures, often without concurrent changes observed on electrophysiology. We present here a critical review of these findings, in optical imaging, SPECT and fMRI, followed by a discussion based on data from intracerebral EEG.
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Affiliation(s)
- Theodore H Schwartz
- Department of Neurosurgery, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, USA
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