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Shrivastava M, Asranna A, Kenchiah R, Mundlamuri R, Viswanathan LG, Kulanthaivelu K, Bharath RD, Saini J, Sadashiva N, Arimappamagan A, Mahadevan A, Rajeswaran J, Malla BR, Sinha S. Yield of video electro encephalography for phase 1 pre-surgical evaluation of drug resistant epilepsy in 1200 adults: retrospective study from a tertiary center situated in a lower-middle-income country. Acta Neurol Belg 2023; 123:1773-1780. [PMID: 35908016 DOI: 10.1007/s13760-022-02031-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/10/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Video Electroencephalography (VEEG) is crucial for presurgical evaluation of Drug Refractory Epilepsy (DRE). The yield of VEEG in large volume centers, particularly those situated in Low-and Middle-Income countries (LMIC) is not well studied. METHODOLOGY We studied 1200 adults with drug resistant focal epilepsy whose seizures were recorded during VEEG in the epilepsy monitoring unit. VEEG review and analysis was done independently by trained epileptologists. Video EEG and MRI data were examined for concordance in order to generate a hypothesis for the presumed epileptogenic zone. RESULTS Analysis of seizure semiology provided information on the symptomatogenic zone in most cases except for 33 (2.75%) patients. A total of 1050 (87.5%) patients showed interictal epileptiform discharges (IEDs) with most (58.3%) showing unilateral IEDs. Most patients (n = 1162, 96.83%) showed ictal EEG discharges of which 951(81.8%) had unilateral ictal onset. Abnormal MRI was seen in 978 (81.5%) patients. Concordance of electroclinical data obtained by analysis of VEEG with MRI abnormality could be established in most patients (63%). Concordance was higher for patients with ictal onset from temporal regions (83.71%) as compared to posterior cortex (55.4%) and frontal regions (43.5%.) CONCLUSION: This study highlights the high yield of VEEG in phase 1 presurgical evaluation in DRE. Systematic evaluation of data from VEEG provided lateralizing and localizing information in most cases. Concordance between VEEG and MRI findings was noted in most patients. These findings support steps to increase referral for pre-surgical evaluation in DRE.
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Affiliation(s)
- Mayank Shrivastava
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Ajay Asranna
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Raghavendra Kenchiah
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Ravindranath Mundlamuri
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | | | - Karthik Kulanthaivelu
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Rose Dawn Bharath
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Jitender Saini
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Nishanth Sadashiva
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | | | - Anita Mahadevan
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Jamuna Rajeswaran
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Bhaskara Rao Malla
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Sanjib Sinha
- NIMHANS: National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India.
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Algahtany M, Abdrabou A, Elhaddad A, Alghamdi A. Advances in Brain Imaging Techniques for Patients With Intractable Epilepsy. Front Neurosci 2021; 15:699123. [PMID: 34421522 PMCID: PMC8377195 DOI: 10.3389/fnins.2021.699123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/20/2021] [Indexed: 11/21/2022] Open
Abstract
Intractable epilepsy, also known as drug resistance or refractory epilepsy, is a major problem affecting nearly one-third of epilepsy patients. Surgical intervention could be an option to treat these patients. Correct identification and localization of epileptogenic foci is a crucial preoperative step. Some of these patients, however, have no abnormality on routine magnetic resonance imaging (MRI) of the brain. Advanced imaging techniques, therefore, can be helpful to identify the area of concern. Moreover, a clear delineation of certain anatomical brain structures and their relation to the surgical lesion or the surgical approach is essential to avoid postoperative complications, and advanced imaging techniques can be very helpful. In this review, we discuss and highlight the use of advanced imaging techniques, particularly positron emission tomography (PET)–MRI, single-photon emission computed tomography, functional MRI, and diffusion tensor imaging–tractography for the preoperative assessment of epileptic patients.
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Affiliation(s)
- Mubarak Algahtany
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ahmed Abdrabou
- Department of Radiology, Ain Shams University, Cairo, Egypt
| | - Ahmed Elhaddad
- Department of Radiology, Mansoura University, Mansoura, Egypt
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Smith G, Stacey WC. The accuracy of quantitative EEG biomarker algorithms depends upon seizure onset dynamics. Epilepsy Res 2021; 176:106702. [PMID: 34229226 DOI: 10.1016/j.eplepsyres.2021.106702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/05/2021] [Accepted: 06/22/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare the performance of different ictal quantitative biomarkers of the seizure onset zone (SOZ) across many seizures in a cohort of consecutive patients with a variety of seizure onset patterns. METHODS The Epileptogenicity Index (EI, a measure of fast activity) and Slow Polarizing Shift index (SPS, a measure of infraslow activity) were calculated for 212 seizures (22 patients). After stratification by onset pattern, median index values inside and outside the SOZ were compared in aggregate and for each of the onset patterns. Receiver Operating Characteristic (ROC) curves were constructed to compare the performance of each index. RESULTS Median values of EI (0.056 vs 0.0087), SPS (0.27 vs 0.19), and CI (0.21 vs 0.12) were significantly higher for contacts inside the SOZ, all p < 0.0001. Analysis of AUC showed variable performance of these indices across seizure types, although AUC for EI and SPS was generally greatest for seizures with fast activity at onset. CONCLUSIONS All indices were significantly higher for contacts inside the SOZ; however, the performance of these indices varied depending on the pattern of seizure onset. SIGNIFICANCE These findings suggest that future studies of quantitative biomarkers of the SOZ should account for seizure onset pattern.
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Affiliation(s)
- Garnett Smith
- Department of Pediatrics, Division of Pediatric Neurology, University of Michigan, 1540 E Hospital Drive, Box 4279, Ann Arbor, MI, 48109-4279, USA.
| | - William C Stacey
- Department of Neurology, University of Michigan, 1500 E Medical Center Drive, SPC 5316, Ann Arbor, MI, 48109-5316, USA; Department of Biomedical Engineering, University of Michigan, 1500 E Medical Center Drive, SPC 5316, Ann Arbor, MI, 48109-5316, USA; Biointerfaces Institute, University of Michigan, 1500 E Medical Center Drive, SPC 5316, Ann Arbor, MI, 48109-5316, USA.
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Mir A, Baradie RA, Alnaim A, Moinuddin A, Khan MI, Jallul T, Otaibi FA, Joseph M, Dossary SA, Bashir S. Utility of single-photon emission computed tomography (SPECT) in presurgical evaluation of children: A single-center experience. Epilepsy Res 2020; 167:106445. [DOI: 10.1016/j.eplepsyres.2020.106445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
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Uribe San Martin R, Di Giacomo R, Mai R, Gozzo F, Pelliccia V, Mariani V, Cardinale F, Ciampi E, Onofrj M, Tassi L. Forecasting Seizure Freedom After Epilepsy Surgery Assessing Concordance Between Noninvasive and StereoEEG Findings. Neurosurgery 2020; 88:113-121. [DOI: 10.1093/neuros/nyaa322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 05/24/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Accurate localization of the probable Epileptogenic Zone (EZ) from presurgical studies is crucial for achieving good prognosis in epilepsy surgery.
OBJECTIVE
To evaluate the degree of concordance at a sublobar localization derived from noninvasive studies (video electroencephalography, EEG; magnetic resonance imaging, MRI; 18-fluorodeoxyglucose positron emission tomography FDG-PET, FDG-PET) and EZ estimated by stereoEEG, in forecasting seizure recurrence in a long-term cohort of patients with focal drug-resistant epilepsy.
METHODS
We selected patients with a full presurgical evaluation and with postsurgical outcome at least 1 yr after surgery. Multivariate Cox regression analysis for seizure freedom (Engel Ia) was performed.
RESULTS
A total of 74 patients were included, 62.2% were in Engel class Ia with a mean follow-up of 2.8 + 2.4 yr after surgery. In the multivariate analysis for Engel Ia vs >Ib, complete resection of the EZ found in stereoEEG (hazard ratio, HR: 0.24, 95%CI: 0.09-0.63, P = .004) and full concordance between FDG-PET and stereoEEG (HR: 0.11, 95%CI: 0.02-0.65, P = .015) portended a more favorable outcome. Most of our results were maintained when analyzing subgroups of patients.
CONCLUSION
The degree of concordance between noninvasive studies and stereoEEG may help to forecast the likelihood of cure before performing resective surgery, particularly using a sublobar classification and comparing the affected areas in the FDG-PET with EZ identified with stereoEEG.
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Affiliation(s)
- Reinaldo Uribe San Martin
- Neurology Department, Pontificia Universidad Católica de Chile, Neurology Service, Complejo Asistencial Hospital Sótero del Río, Santiago, Chile
| | - Roberta Di Giacomo
- Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Roberto Mai
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Francesca Gozzo
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Veronica Pelliccia
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Valeria Mariani
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Francesco Cardinale
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Ethel Ciampi
- Neurology Department, Pontificia Universidad Católica de Chile, Neurology Service, Complejo Asistencial Hospital Sótero del Río, Santiago, Chile
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. D’Annunzio of Chieti-Pescara, Italy
| | - Laura Tassi
- “Claudio Munari” Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
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Alcaraz García-Tejedor G, Echániz G, Strantzas S, Jalloh I, Rutka J, Drake J, Der T. Feasibility of awake craniotomy in the pediatric population. Paediatr Anaesth 2020; 30:480-489. [PMID: 31997512 DOI: 10.1111/pan.13833] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/13/2020] [Accepted: 01/18/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Awake craniotomy with direct cortical stimulation and mapping is the gold standard for resection of lesions near eloquent brain areas, as it can maximize the extent of resection while minimizing the risk of neurological damage. In contrast to the adult population, only small series of awake craniotomies have been reported in children. AIMS The aim of our study is to establish the feasibility of awake craniotomy in the pediatric population. METHODS We performed a retrospective observational study of children undergoing a supratentorial awake craniotomy between January 2009 and April 2019 in a pediatric tertiary care center. Our primary outcome was feasibility of awake craniotomy, defined as the ability to complete the procedure without conversion to general anesthesia. Our secondary outcomes were the incidence of serious intraoperative complications and the mapping completion rate. RESULTS Thirty procedures were performed in 28 children: 12 females and 16 males. The median age was 14 years (range 7-17). The primary diagnosis was tumor (83.3%), epilepsy (13.3%), and arterio-venous malformation (3.3%). The anesthetic techniques were asleep-awake-asleep (96.7%) and conscious sedation (3.3%), all cases supplemented with scalp block and pin-site infiltration. Awake craniotomy was feasible in 29 cases (96.7%), one patient converted to general anesthesia due to agitation. Serious complications occurred in six patients: agitation (6.7%), seizures (3.3%), increased intracranial pressure (3.3%), respiratory depression (3.3%), and bradycardia (3.3%). All complications were quickly resolved and without major consequences. Cortical mapping was completed in 96.6% cases. New neurological deficits occurred in six patients (20%)-moderate in one case and mild in 5-being all absent at 6 months of follow-up. CONCLUSION Awake craniotomy with intraoperative mapping can be successfully performed in children. Adequate patient selection and close cooperation between neurosurgeons, anesthesiologists, neuropsychologists, and neurophysiologists is paramount. Further studies are needed to determine the best anesthetic technique in this population group.
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Affiliation(s)
| | - Gastón Echániz
- Department of Anesthesia, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Samuel Strantzas
- Department of Neurophysiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ibrahim Jalloh
- Department of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - James Rutka
- Department of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - James Drake
- Department of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Tara Der
- Department of Anesthesia, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Foiadelli T, Lagae L, Goffin K, Theys T, De Amici M, Sacchi L, Van Loon J, Savasta S, Jansen K. Subtraction Ictal SPECT coregistered to MRI (SISCOM) as a guide in localizing childhood epilepsy. Epilepsia Open 2019; 5:61-72. [PMID: 32140644 PMCID: PMC7049808 DOI: 10.1002/epi4.12373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 10/28/2019] [Accepted: 11/10/2019] [Indexed: 01/26/2023] Open
Abstract
Objective To assess feasibility and efficacy of subtraction ictal SPECT coregistered to MRI (SISCOM) for epilepsy localization in children who are candidates for resective surgery. Methods We retrospectively reviewed all patients ≤16 years with drug‐resistant epilepsy screened for epilepsy surgery in the University Hospital of Leuven from January 2009 to January 2018. Fifty‐eight hospitalizations for ictal SPECT and 51 SISCOM analyses in 44 patients were included. Mean age was 9.1 years. Hospitalizations for SISCOM were analyzed in terms of multiple variables affecting feasibility and efficacy. The localization of SISCOM was compared with the localization of the presumed epileptogenic zone (PEZ) as determined by video‐EEG. Results SISCOM was feasible in terms of chronic medication management, rescue antiepileptic therapy during hospitalization, and operative timings. Radiotracer injection occurred within 30 seconds from seizure onset in 91.4% of the patients. ictal SPECT imaging was performed within two hours from injection in 100% of the patients (mean: 40 minutes). SISCOM was able to localize the PEZ in 51.0% (26/51) and to additionally lateralize the PEZ in 17.6% (9/51), achieving better localizations than ictal SPECT, FDG‐PET, and MRI (P < .01). SISCOM was useful to localize the PEZ in 25% of patients with poorly localizing video‐EEG and in 27.8% of MRI‐negative cases. The occurrence of habitual seizures during injection for ictal SPECT and the temporal localization of the PEZ both correlated with a better SISCOM localization (P < .05). 36.4% (16/44) patients were finally selected for resective surgery, with a 87.5% seizure‐free rate at 12 months. A localizing SISCOM was associated with seizure freedom in 66.7% and with a Engel I‐II in 75.0% of our patients. Significance SISCOM is a reliable tool to localize the epileptogenic zone in clinical practice and is both feasible and useful in children, adding precious presurgical information especially in patients with noninformative MRI or a poorly localizing video‐EEG.
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Affiliation(s)
- Thomas Foiadelli
- Pediatric Clinic Fondazione IRCCS Policlinico San Matteo University of Pavia Pavia Italy
| | - Lieven Lagae
- Department of Development and Regeneration University Hospitals Leuven Leuven Belgium
| | - Karolien Goffin
- Nuclear Medicine and Molecular Imaging University Hospitals Leuven KU Leuven Leuven Belgium
| | - Tom Theys
- Neurosurgery Department University Hospitals Leuven Leuven Belgium
| | - Mara De Amici
- Laboratory of Immuno-Allergology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Lucia Sacchi
- Department of Electrical, Computer, and Biomedical Engineering University of Pavia Pavia Italy
| | | | - Salvatore Savasta
- Pediatric Clinic Fondazione IRCCS Policlinico San Matteo University of Pavia Pavia Italy
| | - Katrien Jansen
- Department of Development and Regeneration University Hospitals Leuven Leuven Belgium
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Kwatra NS, Lim R, Gee MS, States LJ, Vossough A, Lee EY. PET/MR Imaging:. Magn Reson Imaging Clin N Am 2019; 27:387-407. [DOI: 10.1016/j.mric.2019.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Elkins KC, Moncayo VM, Kim H, Olson LD. Utility of gray-matter segmentation of ictal-Interictal perfusion SPECT and interictal 18 F-FDG-PET in medically refractory epilepsy. Epilepsy Res 2017; 130:93-100. [DOI: 10.1016/j.eplepsyres.2017.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/01/2017] [Accepted: 01/24/2017] [Indexed: 12/20/2022]
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Abstract
Epilepsy is one of the most common neurologic disorders, affecting about 50 million people worldwide. The disease is characterized by recurrent seizures, which are due to aberrant neuronal networks resulting in synchronous discharges. The term epilepsy encompasses a large spectrum of syndromes and diseases with different etiopathogenesis. The recent development of imaging and epilepsy surgery techniques is now enabling the identification of structural abnormalities that are part of the epileptic network, and the removal of these lesions may result in control of seizures. Access of this clinically well-characterized neurosurgical material has provided neuropathologists with the opportunity to study a variety of structural brain abnormalities associated with epilepsy, by combining traditional routine histopathologic methods with molecular genetics and functional analysis of the resected tissue. This approach has contributed greatly to a better diagnosis and classification of these structural lesions, and has provided important new insights into their pathogenesis and epileptogenesis. The present chapter provides a detailed description of the large spectrum of histopathologic findings encountered in epilepsy surgery patients, addressing in particular the nonneoplastic pathologies, including hippocampal sclerosis, malformations of cortical development, Sturge-Weber syndrome, and Rasmussen encephalitis, and reviews current knowledge regarding the underlying molecular pathomechanisms and cellular mechanisms mediating hyperexcitability.
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Affiliation(s)
- Eleonora Aronica
- Department of Neuropathology, Academic Medical Center and Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands; Stichting Epilepsie Instellingen Nederland, the Netherlands.
| | - Angelika Mühlebner
- Department of Neuropathology, Academic Medical Center and Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
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Abstract
First-line treatment for epilepsy is antiepileptic drug and requires an interdisciplinary approach and enduring commitment and adherence from the patient and family for successful outcome. Despite adherence to antiepileptic drugs, refractory epilepsy occurs in approximately 30% of children with epilepsy, and surgical treatment is an important intervention to consider. Surgical management of pediatric epilepsy is highly effective in selected patients with refractory epilepsy; however, an evidence-based protocol, including best methods of presurgical imaging assessments, and neurodevelopmental and/or behavioral health assessments, is not currently available for clinicians. Surgical treatment of epilepsy can be critical to avoid negative outcomes in functional, cognitive, and behavioral health status. Furthermore, it is often the only method to achieve seizure freedom in refractory epilepsy. Although a large literature base can be found for adults with refractory epilepsy undergoing surgical treatment, less is known about how surgical management affects outcomes in children with epilepsy. The purpose of the review was fourfold: (1) to evaluate the available literature regarding presurgical assessment and postsurgical outcomes in children with medically refractory epilepsy, (2) to identify gaps in our knowledge of surgical treatment and its outcomes in children with epilepsy, (3) to pose questions for further research, and (4) to advocate for a more unified presurgical evaluation protocol including earlier referral for surgical candidacy of pediatric patients with refractory epilepsy. Despite its effectiveness, epilepsy surgery remains an underutilized but evidence-based approach that could lead to positive short- and long-term outcomes for children with refractory epilepsy.
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Radhakrishnan R, Leach JL, Mangano FT, Gelfand MJ, Rozhkov L, Miles L, Greiner HM. Prospective detection of cortical dysplasia on clinical MRI in pediatric intractable epilepsy. Pediatr Radiol 2016; 46:1430-8. [PMID: 27112159 DOI: 10.1007/s00247-016-3623-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/08/2016] [Accepted: 03/30/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cortical dysplasia is the most common cause of pediatric refractory epilepsy. MRI detection of epileptogenic lesion is associated with good postsurgical outcome. Additional electrophysiological information is suggested to be helpful in localization of cortical dysplasia. Educational measures were taken to increase the awareness of cortical dysplasia at our institution in the context of a recent International League Against Epilepsy (ILAE 2011) classification of cortical dysplasia. OBJECTIVE To determine changes in the rate of prospective identification of cortical dysplasia on an initial radiology report and also evaluate the benefit of MRI review as part of a multidisciplinary epilepsy conference in identifying previously overlooked MRI findings. MATERIALS AND METHODS We retrospectively evaluated surgically treated children with refractory epilepsy from 2007 to 2014 with cortical dysplasia on histopathology. We analyzed the initial radiology report, preoperative MRI interpretation at multidisciplinary epilepsy conference and subsequent retrospective MRI review with knowledge of the resection site. We recorded additional electrophysiological data and the presence of lobar concordance with the MRI findings. RESULTS Of 78 children (44 MRI lesional) evaluated, 18 had initially overlooked MRI findings. Comparing 2007-2010 to 2011-2014, there was improvement in the rate of overlooked findings on the initial radiology report (54% vs. 13% of lesional cases, respectively; P = 0.008). The majority (72%) were identified at a multidisciplinary conference with lobar concordance of findings with at least one additional electrophysiological investigation in 89%. CONCLUSION Awareness of current classification schemes of cortical dysplasia and image review in the context of a multidisciplinary conference can lead to improved MRI detection of cortical dysplasia in children.
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Affiliation(s)
- Rupa Radhakrishnan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229, USA.
| | - James L Leach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229, USA
| | - Francesco T Mangano
- Department of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael J Gelfand
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229, USA
| | - Leonid Rozhkov
- Department of Neurology, Comprehensive Epilepsy Treatment Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lili Miles
- Department of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hansel M Greiner
- Department of Neurology, Comprehensive Epilepsy Treatment Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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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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Abstract
Pediatric neurology relies on ultrasound, computed tomography (CT), and magnetic resonance (MR) imaging. CT prevails in acute neurologic presentations, including traumatic brain injury (TBI), nontraumatic coma, stroke, and status epilepticus, because of easy availability, with images of diagnostic quality, e.g., to exclude hemorrhage, usually completed quickly enough to avoid sedation. Concerns over the risks of ionizing radiation mean re-imaging and higher-dose procedures, e.g., arteriography and venography, require justification. T1/T2-weighted imaging (T1/T2-WI) MR with additional sequences (arteriography, venography, T2*, spectroscopy, diffusion tensor, perfusion, diffusion- (DWI) and susceptibility-weighted imaging (SWI)) often clarifies the diagnosis, which may alter management in acute settings, as well as chronic conditions, e.g., epilepsy. Clinical acumen remains essential to avoid imaging, e.g., in genetic epilepsies or migrainous headaches responding to treatment, or to target sequences to specific diagnosis, e.g., T1/T2-WI for shunt dysfunction (with SWI for TBI); DWI, arteriography including neck vessels, and venography for acute hemiplegia or coma; coronal temporal cuts for partial epilepsy; or muscle imaging for motor delay. The risk of general anesthesia is low; "head-only" scanners may allow rapid MRI without sedation. Timely and accurate reporting, with discrepancy discussion between expert neuroradiologists, is important for management of the child and the family's expectations.
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Abstract
AbstractThe role of fludeoxyglucose F 18 positron emission tomography (PET) in the presurgical evaluation of patients with medically intractable epilepsy continues to be refined. The purpose of this study was to systematically review the literature to assess the diagnostic accuracy and utility of PET in this setting. Thirty-nine studies were identified through MEDLINE and EMBASE databases that met the inclusion criteria. In adult patients, PET hypometabolism showed a 56 to 90% agreement with seizure onset localized by intracranial electroencephalogram (pediatric: 21 to 86%). In temporal lobe epilepsy patients with good surgical outcome, PET displayed moderate to high sensitivity in localizing the seizure focus (range: 71 to 89%). The sensitivity increased by 8 to 23% when PET results were combined with magnetic resonance imaging or electroencephalogram. PET has been shown to affect patient management by improving the guidance of intracranial electrodes placement, altering the decision to perform surgery, or excluding patients from further evaluation.
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Kim JY, Kang HC, Kim K, Kim HD, Im CH. Localization of epileptogenic zones in Lennox-Gastaut syndrome (LGS) using graph theoretical analysis of ictal intracranial EEG: a preliminary investigation. Brain Dev 2015; 37:29-36. [PMID: 24630492 DOI: 10.1016/j.braindev.2014.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 02/13/2014] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Precise localization of epileptogenic zones is essential for the successful surgical treatment of refractory epilepsy including Lennox-Gastaut syndrome (LGS). The surgical resection areas are generally determined by epileptologists based on diverse neuroimaging modalities; however, exact epileptogenic zones cannot be accurately localized in many patients with LGS using the conventional methods. Therefore, new reliable algorithms are still required for enhancing the success rate of the resective epilepsy surgery. In the present study, we introduce an approach to localize epileptogenic zones in LGS based on the graph theoretical analysis of ical intracranial EEG (iEEG). METHODS Four patients with LGS who became seizure-free after the resective epilepsy surgery were selected. Before the surgery, their epileptogenic zones were delineated using EEG, iEEG, and several conventional imaging modalities. Phase locking value (PLV) analysis was applied to construct functional connectivity networks during ictal events, and then several graph theoretical indices including betweenness centrality (BC) were evaluated for each iEEG sensor to find the primary hubs of the ictal epileptic network. The graph theoretical index values were then overlaid on 3D individual cortical surface. RESULTS The iEEG channels with high BC values coincided well with the surgical resection areas. Among various graph theoretical measures such as local efficiency, participation coefficient, and eigenvector centrality, only BC showed fair correspondence with the surgical resection areas. CONCLUSIONS The primary hubs in the ictal epileptic networks coincided well with areas of surgical resection in LGS patients with successful surgical outcomes. This observation warrants further studies to determine if the graph theoretical network analysis of ictal iEEG recordings can serve as a new auxiliary tool to localize epileptogenic zones in LGS.
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Affiliation(s)
- Jeong-Youn Kim
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Hoon-Chul Kang
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Kiwoong Kim
- Korea Research Institute of Standard and Science (KRISS), Daejeon, South Korea
| | - Heung Dong Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang-Hwan Im
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea.
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Kim JY, Kang HC, Cho JH, Lee JH, Kim HD, Im CH. Combined use of multiple computational intracranial EEG analysis techniques for the localization of epileptogenic zones in Lennox-Gastaut syndrome. Clin EEG Neurosci 2014; 45:169-78. [PMID: 24553310 DOI: 10.1177/1550059413495393] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Traditionally, identification of epileptogenic zones primarily relied on visual inspection of intracranial electroencephalography (iEEG) recordings by experienced epileptologists; however, removal of epileptogenic zones identified by iEEG does not always guarantee favorable surgical outcomes. To confirm visual inspection results, and assist in making decisions about surgical resection areas, computational iEEG analysis methods have recently been used for the localization of epileptogenic zones. In this study, we have proposed a new approach for the localization of epileptogenic zones in Lennox-Gastaut syndrome (LGS), and have investigated whether the proposed approach could confirm surgical resection areas and predict seizure outcome before surgery. The proposed approach simultaneously used results of 2 iEEG analysis methods, directed transfer function (DTF) and time delay estimation, to enhance localization accuracy. This new combined method was applied to patients who became seizure-free after resective epilepsy surgery, as well as those who had unsuccessful surgery. A quantitative metric was also introduced that can measure how well the localized epileptogenic zones coincided with the surgical resection areas, with the aim of verifying whether the approach could confirm surgical resection areas determined by epileptologists. The estimated epileptogenic zones more strongly coincided with surgical resection areas in patients with successful, compared to those with unsuccessful surgical outcomes. Both qualitative and quantitative analyses showed that the combined use of 2 iEEG analyses resulted in a more accurate estimate of epileptogenic zones in LGS than the use of a single method. A combination of multiple iEEG analyses could not only enhance overall accuracy of localizing epileptogenic zones in LGS, but also has the potential to predict outcomes before resective surgery.
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Affiliation(s)
- Jeong-Youn Kim
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Hoon-Chul Kang
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae-Hyun Cho
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Ji Hyun Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Heung Dong Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang-Hwan Im
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
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Perissinotti A, Setoain X, Aparicio J, Rubí S, Fuster BM, Donaire A, Carreño M, Bargalló N, Rumiá J, Garcia-Fructuoso G, Mayoral M, Sanmartí F, Pons F. Clinical Role of Subtraction Ictal SPECT Coregistered to MR Imaging and 18F-FDG PET in Pediatric Epilepsy. J Nucl Med 2014; 55:1099-105. [DOI: 10.2967/jnumed.113.136432] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/17/2014] [Indexed: 11/16/2022] Open
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19
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Setoain X, Carreño M, Pavía J, Martí-Fuster B, Campos F, Lomeña F. PET and SPECT in epilepsy. Rev Esp Med Nucl Imagen Mol 2014. [DOI: 10.1016/j.remnie.2014.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Purz S, Sabri O, Viehweger A, Barthel H, Kluge R, Sorge I, Hirsch FW. Potential Pediatric Applications of PET/MR. J Nucl Med 2014; 55:32S-39S. [PMID: 24762622 DOI: 10.2967/jnumed.113.129304] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Medical imaging with multimodality and whole-body technologies has continuously improved in recent years. The advent of combined modalities such as PET/CT and PET/MR offers new tools with an exact fusion of molecular imaging and high-resolution anatomic imaging. For noninvasive pediatric diagnostics, molecular imaging and whole-body MR have become important, especially in pediatric oncology. Because it has a lower radiation exposure than PET/CT, combined PET/MR is expected to be of special use in pediatric diagnostics. This review focuses on possible pediatric applications of PET/MR hybrid imaging, particularly pediatric oncology and neurology but also the diagnosis of infectious or inflammatory diseases.
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Affiliation(s)
- Sandra Purz
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany; and
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany; and
| | - Adrian Viehweger
- Department of Pediatric Radiology, University Hospital of Leipzig, Leipzig, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany; and
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany; and
| | - Ina Sorge
- Department of Pediatric Radiology, University Hospital of Leipzig, Leipzig, Germany
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21
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Pittau F, Grouiller F, Spinelli L, Seeck M, Michel CM, Vulliemoz S. The role of functional neuroimaging in pre-surgical epilepsy evaluation. Front Neurol 2014. [PMID: 24715886 DOI: 10.3389/fneur.2014.00031.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The prevalence of epilepsy is about 1% and one-third of cases do not respond to medical treatment. In an eligible subset of patients with drug-resistant epilepsy, surgical resection of the epileptogenic zone is the only treatment that can possibly cure the disease. Non-invasive techniques provide information for the localization of the epileptic focus in the majority of cases, whereas in others invasive procedures are required. In the last years, non-invasive neuroimaging techniques, such as simultaneous recording of functional magnetic resonance imaging and electroencephalogram (EEG-fMRI), positron emission tomography (PET), single photon emission computed tomography (SPECT), electric and magnetic source imaging (MSI, ESI), spectroscopy (MRS), have proved their usefulness in defining the epileptic focus. The combination of these functional techniques can yield complementary information and their concordance is crucial for guiding clinical decision, namely the planning of invasive EEG recordings or respective surgery. The aim of this review is to present these non-invasive neuroimaging techniques, their potential combination, and their role in the pre-surgical evaluation of patients with pharmaco-resistant epilepsy.
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Affiliation(s)
- Francesca Pittau
- Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland
| | - Frédéric Grouiller
- Department of Radiology and Medical Informatics, University Hospital of Geneva , Geneva , Switzerland
| | - Laurent Spinelli
- Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland
| | - Margitta Seeck
- Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland
| | - Christoph M Michel
- Functional Brain Mapping Laboratory, Department of Fundamental Neurosciences, University of Geneva , Geneva , Switzerland
| | - Serge Vulliemoz
- Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland
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22
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Abstract
Surgery of focal epilepsies in childhood has largely benefited from the recent advances of the noninvasive functional imaging techniques, particularly SPECT which presurgically contributes to the localization of the seizure onset zone, in order to select the patients, decide the optimal placement of intracranial electrodes, and plan the resection. Peri-ictal SPECT (ictal and postictal) proved especially useful when video-EEG is not contributory, when MRI looks normal or shows multiple abnormalities, or in cases of discrepant findings within the presurgery workup. Because of a poor temporal resolution, peri-ictal SPECT must be coupled with video-EEG. Multimodal imaging so-called SISCOM (peri-ictal - interictal SPECT subtraction image superimposed on MRI) increases the sensitivity of peri-ictal SPECT by about 70% and makes it a good predictor of seizure-free outcome after surgery. In addition, interictal SPECT occasionally provides some interesting results regarding functional cortical maturation and learning disorders in childhood.
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Pittau F, Grouiller F, Spinelli L, Seeck M, Michel CM, Vulliemoz S. The role of functional neuroimaging in pre-surgical epilepsy evaluation. Front Neurol 2014; 5:31. [PMID: 24715886 PMCID: PMC3970017 DOI: 10.3389/fneur.2014.00031] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 03/06/2014] [Indexed: 12/25/2022] Open
Abstract
The prevalence of epilepsy is about 1% and one-third of cases do not respond to medical treatment. In an eligible subset of patients with drug-resistant epilepsy, surgical resection of the epileptogenic zone is the only treatment that can possibly cure the disease. Non-invasive techniques provide information for the localization of the epileptic focus in the majority of cases, whereas in others invasive procedures are required. In the last years, non-invasive neuroimaging techniques, such as simultaneous recording of functional magnetic resonance imaging and electroencephalogram (EEG-fMRI), positron emission tomography (PET), single photon emission computed tomography (SPECT), electric and magnetic source imaging (MSI, ESI), spectroscopy (MRS), have proved their usefulness in defining the epileptic focus. The combination of these functional techniques can yield complementary information and their concordance is crucial for guiding clinical decision, namely the planning of invasive EEG recordings or respective surgery. The aim of this review is to present these non-invasive neuroimaging techniques, their potential combination, and their role in the pre-surgical evaluation of patients with pharmaco-resistant epilepsy.
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Affiliation(s)
- Francesca Pittau
- Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland
| | - Frédéric Grouiller
- Department of Radiology and Medical Informatics, University Hospital of Geneva , Geneva , Switzerland
| | - Laurent Spinelli
- Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland
| | - Margitta Seeck
- Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland
| | - Christoph M Michel
- Functional Brain Mapping Laboratory, Department of Fundamental Neurosciences, University of Geneva , Geneva , Switzerland
| | - Serge Vulliemoz
- Presurgical Epilepsy Evaluation Unit, Neurology Department, University Hospital of Geneva , Geneva , Switzerland
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24
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Setoain X, Carreño M, Pavía J, Martí-Fuster B, Campos F, Lomeña F. [PET and SPECT in epilepsy]. Rev Esp Med Nucl Imagen Mol 2014; 33:165-74. [PMID: 24565567 DOI: 10.1016/j.remn.2014.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 01/22/2014] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
Abstract
Epilepsy is one of the most frequent chronic neurological disorders, affecting 1-2% of the population. Patients with complex partial drug resistant episodes may benefit from a surgical treatment consisting in the excision of the epileptogenic area. Localization of the epileptogenic area was classically performed with video-EEG and magnetic resonance (MR). Recently, functional neuroimaging studies of Nuclear Medicine, positron emission tomography (PET) and single photon emission tomography (SPECT) have demonstrated their utility in the localization of the epileptogenic area prior to surgery. Ictal SPECT with brain perfusion tracers show an increase in blood flow in the initial ictal focus, while PET with (18)FDG demonstrates a decrease of glucose metabolism in the interictal functional deficit zone. In this review, the basic principles and methodological characteristics of the SPECT and PET in epilepsy are described. The ictal SPECT injection mechanism, different patterns of perfusion based on the time of ictal, postictal or interictal injection are detailed and the different diagnostic sensitivities of each one of these SPECT are reviewed. Different methods of analysis of the images with substraction and fusion systems with the MR are described. Similarly, the injection methodology, quantification and evaluation of the images of the PET in epilepsy are described. Finally, the main clinical indications of SPECT and PET in temporal and extratemporal epilepsy are detailed.
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Affiliation(s)
- X Setoain
- Servicio de Medicina Nuclear, Hospital Clínic de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Grupo de imagen biomédica, Barcelona, España.
| | - M Carreño
- Servicio de Neurología, Hospital Clínic de Barcelona, Barcelona, España
| | - J Pavía
- Servicio de Medicina Nuclear, Hospital Clínic de Barcelona, Barcelona, España; Facultad de Medicina, Universitat de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Grupo de imagen biomédica, Barcelona, España
| | - B Martí-Fuster
- Facultad de Medicina, Universitat de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Grupo de imagen biomédica, Barcelona, España
| | - F Campos
- Servicio de Medicina Nuclear, Hospital Clínic de Barcelona, Barcelona, España
| | - F Lomeña
- Servicio de Medicina Nuclear, Hospital Clínic de Barcelona, Barcelona, España; Facultad de Medicina, Universitat de Barcelona, Barcelona, España
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25
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Zhang J, Liu W, Chen H, Xia H, Zhou Z, Mei S, Liu Q, Li Y. Multimodal neuroimaging in presurgical evaluation of drug-resistant epilepsy. NEUROIMAGE-CLINICAL 2013; 4:35-44. [PMID: 24282678 PMCID: PMC3840005 DOI: 10.1016/j.nicl.2013.10.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 09/21/2013] [Accepted: 10/25/2013] [Indexed: 01/12/2023]
Abstract
Intracranial EEG (icEEG) monitoring is critical in epilepsy surgical planning, but it has limitations. The advances of neuroimaging have made it possible to reveal epileptic abnormalities that could not be identified previously and improve the localization of the seizure focus and the vital cortex. A frequently asked question in the field is whether non-invasive neuroimaging could replace invasive icEEG or reduce the need for icEEG in presurgical evaluation. This review considers promising neuroimaging techniques in epilepsy presurgical assessment in order to address this question. In addition, due to large variations in the accuracies of neuroimaging across epilepsy centers, multicenter neuroimaging studies are reviewed, and there is much need for randomized controlled trials (RCTs) to better reveal the utility of presurgical neuroimaging. The results of multiple studies indicate that non-invasive neuroimaging could not replace invasive icEEG in surgical planning especially in non-lesional or extratemporal lobe epilepsies, but it could reduce the need for icEEG in certain cases. With technical advances, multimodal neuroimaging may play a greater role in presurgical evaluation to reduce the costs and risks of epilepsy surgery, and provide surgical options for more patients with drug-resistant epilepsy.
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Affiliation(s)
- Jing Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, PR China
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26
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Kassem H, El Shiekh F, Wafaie A, Abdelfattah S, Farghaly H, Afifi L. Presurgical evaluation of refractory temporal lobe epilepsy: Comparison of MR imaging, PET and ictal SPECT in localization of the epileptogenic substrate. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Mason KP, Robinson F, Fontaine P, Prescilla R. Dexmedetomidine Offers an Option for Safe and Effective Sedation for Nuclear Medicine Imaging in Children. Radiology 2013; 267:911-7. [DOI: 10.1148/radiol.13121232] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Juhász C. The impact of positron emission tomography imaging on the clinical management of patients with epilepsy. Expert Rev Neurother 2013; 12:719-32. [PMID: 22650174 DOI: 10.1586/ern.12.48] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Clinical positron emission tomography (PET) imaging of human epilepsy has a 30-year history, but it is still searching for its exact role among rapidly advancing neuroimaging techniques. The vast majority of epilepsy PET studies used this technique to improve detection of epileptic foci for surgical resection. Here, we review the main trends emerging from three decades of PET research in epilepsy, with a particular emphasis on how PET imaging has impacted on the clinical management of patients with intractable epilepsy. While reviewing the latest studies, we also present an argument for a changing role of PET and molecular imaging in the future, with an increasing focus on epileptogenesis and newly discovered molecular mechanisms of epilepsy. These new applications will be facilitated by technological advances, such as the use of integrated PET/MRI systems and utilization of novel radiotracers, which may also enhance phenotype-genotype correlations and assist rational, individualized treatment strategies.
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Affiliation(s)
- Csaba Juhász
- Department of Pediatrics, Wayne State University School of Medicine, PET Center, Children's Hospital of Michigan, Detroit, MI 48201, USA.
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29
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Widjaja E, Shammas A, Vali R, Otsubo H, Ochi A, Snead OC, Go C, Charron M. FDG-PET and magnetoencephalography in presurgical workup of children with localization-related nonlesional epilepsy. Epilepsia 2013; 54:691-9. [DOI: 10.1111/epi.12114] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2012] [Indexed: 11/28/2022]
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30
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Cho JH, Kang HC, Jung YJ, Kim JY, Kim HD, Yoon DS, Lee YH, Im CH. Localization of epileptogenic zones in Lennox–Gastaut syndrome using frequency domain source imaging of intracranial electroencephalography: a preliminary investigation. Physiol Meas 2013; 34:247-63. [DOI: 10.1088/0967-3334/34/2/247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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31
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Archambaud F, Bouilleret V, Hertz-Pannier L, Chaumet-Riffaud P, Rodrigo S, Dulac O, Chassoux F, Chiron C. Optimizing statistical parametric mapping analysis of 18F-FDG PET in children. EJNMMI Res 2013; 3:2. [PMID: 23289862 PMCID: PMC3558387 DOI: 10.1186/2191-219x-3-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 12/27/2012] [Indexed: 01/18/2023] Open
Abstract
UNLABELLED BACKGROUND Statistical parametric mapping (SPM) procedure is an objective tool to analyze 18F-fluoro-2-deoxy-d-glucose-positron-emission tomography (FDG-PET) images and a useful complement to visual analysis. However, SPM requires a comparison to control data set that cannot be obtained in healthy children for ethical reasons. Using adults as controls showed some limitations. The purpose of the present study was to generate and validate a group of pseudo-normal children as a control group for FDG-PET studies in pediatrics. METHODS FDG-PET images of 47 children (mean ± SD age 10.2 ± 3.1 years) with refractory symptomatic (MRI-positive, n = 20) and cryptogenic (MRI-negative, n = 27) focal epilepsy planned for surgery were analyzed using visual and SPM analysis. Performances of SPM analysis were compared using two different control groups: (1) an adult control group consisting of healthy young adults (n = 25, 30.5 ± 5.8 years, adult PET template) and (2) a pediatric pseudo-control group consisting of patients (n = 24, 10.6 ± 3.1 years, children PET template) with refractory focal epilepsy but with negative MRI and with PET considered normal not only on visual analysis but also on SPM. RESULTS Among the 47 children, visual analysis succeeded detecting at least one hypometabolic area in 87% of the cases (interobserver kappa = 0.81). Regarding SPM analysis, the best compromise between sensitivity and specificity was obtained with a threshold of p less than 0.001 as an extent of more than 40 voxels. There was a significant concordance to detect hypometabolic areas between both SPM analyses [kappa (K) = 0.59; p < 0.005] and between both SPM and visual analyses (K = 0.45; p < 0.005), in symptomatic (K = 0.74; p < 0.005) as in cryptogenic patients (K = 0.26; p < 0.01). The pediatric pseudo-control group dramatically improved specificity (97% vs. 89%; p < 0.0001) by increasing the positive predictive value (86% vs. 65%). Sensitivity remained acceptable although it was not better (79% vs. 87%, p = 0.039). The main impact was to reduce by 41% the number of hypometabolic cortical artifacts detected by SPM, especially in the younger epileptic patients, which is a key point in clinical practice. CONCLUSIONS This age-matched pseudo-control group is a way to optimize SPM analysis of FDG-PET in children with epilepsy. It might also be considered for other brain pathologies in pediatrics in the future.
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Affiliation(s)
- Frederique Archambaud
- Inserm, U663, Service de Neurologie et Métabolisme, Hôpital Necker, 149 rue de Sèvres, Paris, 75015, France.
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32
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Cho JH, Kang HC, Jung YJ, Lee YH, Jung KY, Kim HD, Im CH. Localization of ictal onset zones in Lennox–Gastaut syndrome (LGS) based on information theoretical time delay analysis of intracranial electroencephalography (iEEG). Epilepsy Res 2012; 99:78-86. [DOI: 10.1016/j.eplepsyres.2011.10.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/09/2011] [Accepted: 10/15/2011] [Indexed: 11/27/2022]
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33
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Imaging in epilepsy: Functional studies. RADIOLOGIA 2012. [DOI: 10.1016/j.rxeng.2012.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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34
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[Imaging in epilepsy: functional studies]. RADIOLOGIA 2011; 54:124-36. [PMID: 21963255 DOI: 10.1016/j.rx.2011.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 05/06/2011] [Accepted: 05/10/2011] [Indexed: 11/22/2022]
Abstract
Neuroimaging studies play a fundamental role in the diagnosis and evaluation of epilepsy. Technological advances in neuroimaging techniques have made it possible to obtain functional as well as structural information. The pathophysiology of epilepsy consists of an abnormal increase in cerebral activity that can be appreciated on neuroimaging techniques like functional magnetic resonance imaging (fMRI), PET, and SPECT. In patients with epilepsy that is refractory to drug therapy, the main aim of surgery is to control seizures and thus to improve the quality of life. In the preoperative workup of these patients, fMRI has an increasingly important role, evaluating the location of functional areas that must be safeguarded during surgery.
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35
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Hsin YL, Chuang MF, Shen TW, Harnod T. Temporo-spatial analyses define epileptogenic and functional zones in a case of Dyke-Davidoff-Masson syndrome. Seizure 2011; 20:713-6. [PMID: 21764333 DOI: 10.1016/j.seizure.2011.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 06/26/2011] [Accepted: 06/27/2011] [Indexed: 11/16/2022] Open
Abstract
Dyke-Davidoff-Masson syndrome (DDMS) is a rare epilepsy syndrome that is characterized by cerebral hemiatrophy, homolateral skull hyperplasia, hyperpneumatization of the paranasal sinuses, seizures with or without mental retardation, and contralateral hemiparesis. We describe a case of DDMS in a 40-year-old female who had complex partial seizures with occasional secondary generalization since the age of 4 years. Her seizure frequency was 10-20 seizures/month even though she took four antiepileptic drugs. We applied magnetic resonance imaging (MRI), positron emission tomography (PET), functional MRI, and invasive electroencephalography (EEG) to define her epileptogenic and functional zones. Brain MRI showed prominent atrophy in the left frontal dorsal and lateral regions and mild atrophy of the left superior temporal gyrus and left parietal gyri. Interictal PET revealed decreased glucose metabolism in the atrophic regions. Functional MRI demonstrated that the inferior frontal and inferior parieto-occipital regions of the right hemisphere were activated by language testing. Invasive EEG revealed that the left lateral temporal lobe was the sole source of her seizures. Our results imply that the "metabolic border zone" rather than the atrophic region plays an important role in seizure activity, and that reorganization of functional zones occur after cerebral damage early in life.
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Affiliation(s)
- Y L Hsin
- Department of Neurology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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36
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Doelken MT, Mennecke A, Huppertz HJ, Rampp S, Lukacs E, Kasper BS, Kuwert T, Ritt P, Doerfler A, Stefan H, Hammen T. Multimodality approach in cryptogenic epilepsy with focus on morphometric 3T MRI. J Neuroradiol 2011; 39:87-96. [PMID: 21723607 DOI: 10.1016/j.neurad.2011.04.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 04/12/2011] [Accepted: 04/28/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to investigate the potential contribution of morphometric MRI analysis in comparison to other modalities, such as MEG, SPECT and PET, in identifying the epileptogenic focus in patients with cryptogenic epilepsy. PATIENTS AND METHODS Study inclusion was limited to epilepsy patients with a monolobar focus hypothesis, as concluded from EEG/seizure semiology and the best individual concordance rate. Feature maps, generated by the MATLAB(®) "morphometric analysis program" (MAP), were evaluated by a neuroradiologist blinded to conventional MRI and the focus hypothesis (MAP(1)). In addition, the feature maps were also interpreted by simultaneous matching conventional MRI but, again, with the reader having no knowledge of the focus hypothesis (MAP(2)). RESULTS In 12 out of 51 patients, true-positive findings were achieved (MAP(1): sensitivity 24%; specificity 96%). The sensitivity of the MAP(1) results was superior extratemporally. After matching conventional MRI, FCD was traced in six of the 12 patients (MAP(2): sensitivity 12%; specificity 100%). MEG sensitivity was 62%. Sensitivity of interictal and ictal SPECT was 20% and 50%, respectively. PET was not as sensitive extratemporally (19%) as temporally (82%). The greatest correspondence with the best individual concordance rate was noted with PET (14/16; 88%) and MEG (8/10; 80%), followed by interictal (5/8; 63%) and ictal (9/15; 60%) SPECT. Results for MAP(1) were 53% (10/19), and 100% for MAP(2) (6/6). CONCLUSION Although MAP sensitivity and specificity results are lower in comparison to other modalities, implementation of the technique should be considered first, before arranging any further investigations. The present study results offer guidelines for the implementation, interpretation and concordance of diagnostic procedures.
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Affiliation(s)
- M T Doelken
- Department of Neuroradiology, Friedrich-Alexander-University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
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Jung YJ, Kang HC, Choi KO, Lee JS, Kim DS, Cho JH, Kim SH, Im CH, Kim HD. Localization of ictal onset zones in Lennox-Gastaut syndrome using directional connectivity analysis of intracranial electroencephalography. Seizure 2011; 20:449-57. [PMID: 21515079 DOI: 10.1016/j.seizure.2011.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 02/01/2011] [Accepted: 02/07/2011] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Neuroscientists are becoming interested in the application of computational EEG analysis to the identification of ictal onset zones; however, most studies have focused on the localization of ictal onset zones in focal epilepsy. The present study aimed to estimate the ictal onset zone of Lennox-Gastaut syndrome (LGS) with bilaterally synchronous epileptiform discharges from intracranial electroencephalography (iEEG) recordings using directional connectivity analysis. METHODS We analyzed ictal iEEG data acquired from three LGS patients who underwent epileptic surgery with favorable surgical outcomes. To identify the ictal onset zones, we estimated the functional directional connectivity network among the intracerebral electrodes using the directed transfer function (DTF) method. RESULTS The analysis results demonstrated that areas with high average outflow values corresponded well with the surgical resection areas identified using electrophysiologic data and conventional neuroimaging modalities. DISCUSSIONS Our results suggest that the DTF analysis can be a useful auxiliary tool for determining surgical resection areas prior to epilepsy surgery in LGS patients. This is the first research article demonstrating that directional connectivity analysis of iEEG recording data can be used for delineating surgical resection areas in generalized epilepsy patients who need surgical treatment.
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Affiliation(s)
- Young-Jin Jung
- Department of Biomedical Engineering, Yonsei University, Wonju, Kangwon-do, Republic of Korea
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Jafari-Khouzani K, Elisevich K, Karvelis KC, Soltanian-Zadeh H. Quantitative multi-compartmental SPECT image analysis for lateralization of temporal lobe epilepsy. Epilepsy Res 2011; 95:35-50. [PMID: 21454055 DOI: 10.1016/j.eplepsyres.2011.02.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 02/19/2011] [Accepted: 02/21/2011] [Indexed: 11/16/2022]
Abstract
This study assesses the utility of compartmental analysis of SPECT data in lateralizing ictal onset in cases of a putative mesial temporal lobe epilepsy (mTLE). An institutional archival review provided 46 patients (18M, 28F) operated for a putative mTLE who achieved an Engel class Ia postoperative outcome. This established the standard to assure a true ictal origin. Ictal and interictal SPECT images were separately coregistered to T1-weighted (T1W) magnetic resonance (MR) image using a rigid transformation and the intensities matched with an l(1) norm minimization technique. The T1W MR image was segmented into separate structures using an atlas-based automatic segmentation technique with the hippocampi manually segmented to improve accuracy. Mean ictal-interictal intensity difference values were calculated for select subcortical structures and the accuracy of lateralization evaluated using a linear classifier. Hippocampal SPECT analysis yielded the highest lateralization accuracy (91%) followed by the amygdala (87%), putamen (67%) and thalamus (61%). Comparative FLAIR and volumetric analyses yielded 89% and 78% accuracies, respectively. A multi-modality analysis did not generate a higher accuracy (89%). A quantitative anatomically compartmented approach to SPECT analysis yields a particularly high lateralization accuracy in the case of mTLE comparable to that of quantitative FLAIR MR imaging. Hippocampal segmentation in this regard correlates well with ictal origin and shows good reliability in the preoperative analysis.
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Affiliation(s)
- Kourosh Jafari-Khouzani
- Department of Diagnostic Radiology, Henry Ford Hospital, One Ford Place, Detroit, MI 48202, USA.
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Kim YH, Kang HC, Kim DS, Kim SH, Shim KW, Kim HD, Lee JS. Neuroimaging in identifying focal cortical dysplasia and prognostic factors in pediatric and adolescent epilepsy surgery. Epilepsia 2011; 52:722-7. [DOI: 10.1111/j.1528-1167.2010.02950.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jung DE, Lee JS. Multimodal neuroimaging in presurgical evaluation of childhood epilepsy. KOREAN JOURNAL OF PEDIATRICS 2010; 53:779-85. [PMID: 21189974 PMCID: PMC3004492 DOI: 10.3345/kjp.2010.53.8.779] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Revised: 07/12/2010] [Accepted: 07/15/2010] [Indexed: 11/27/2022]
Abstract
In pre-surgical evaluation of pediatric epilepsy, the combined use of multiple imaging modalities for precise localization of the epileptogenic focus is a worthwhile endeavor. Advanced neuroimaging by high field Magnetic resonance imaging (MRI), diffusion tensor images, and MR spectroscopy have the potential to identify subtle lesions. 18F-FDG positron emission tomography and single photon emission tomography provide visualization of metabolic alterations of the brain in the ictal and interictal states. These techniques may have localizing value for patients which exhibit normal MRI scans. Functional MRI is helpful for non-invasively identifying areas of eloquent cortex. These advances are improving our ability to noninvasively detect epileptogenic foci which have gone undetected in the past and whose accurate localization is crucial for a favorable outcome following surgical resection.
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Affiliation(s)
- Da Eun Jung
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
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Cascino GD, Theodore WH. EPILEPSY SURGERY AND ELECTRONIC DEVICES. Continuum (Minneap Minn) 2010; 16:179-98. [DOI: 10.1212/01.con.0000368238.49610.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Neuroimaging is essential in the work-up of patients with intractable epilepsy. In pediatric patients with medically refractory epilepsy, cortical dysplasias account for a large percentage of the epileptogenic substrate. Unfortunately, these are also the most subtle lesions to identify. For this reason, there has been ongoing interest in utilizing new advanced magnetic resonance imaging (MRI) techniques to improve the ability to identify, diagnose, characterize, and delineate cortical dysplasias. Technologic gains such as multichannel coils (32 phased array and beyond) and higher field strengths (3T, 7T, and greater) coupled with newer imaging sequences such as arterial spin labeling (ASL), susceptibility weighted imaging (SWI) and diffusion tensor/spectrum imaging (DTI/DSI) are likely to increase yield. Improved MRI techniques coupled with a multimodality approach including magnetoencephalography (MEG), positron emission tomography (PET), and other techniques will increase sensitivity and specificity for identifying cortical dysplasias.
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Affiliation(s)
- Neel Madan
- Division of Pediatric Radiology, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
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