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Alis C, Alis D, Uslu Besli L, Karaarslan E, Sonmezoglu K, Ozkara C, Yeni SN. The analysis of 18 F-FDG PET/MRI, electroencephalography, and semiology in patients with gray matter heterotopia: A pilot study. Acta Neurol Scand 2022; 146:662-670. [PMID: 36102058 DOI: 10.1111/ane.13705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/29/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe 18 F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18 F-FDG PET/MRI) along with semiology and electroencephalography (EEG) in patients with gray matter heterotopia (GMH); to evaluate the concordance between 18 F-FDG PET/MRI and clinical epileptogenic zone (EZ). MATERIALS & METHODS GMH (subcortical heterotopia [SCH] and periventricular nodular heterotopia [PNH]) patients with epilepsy who underwent 18 F-FDG PET/MRI were retrospectively enrolled. Two radiologists evaluated brain MRI, while two nuclear medicine specialists assessed the 18 F-FDG PET. The SUVmax values of visually hypometabolic cortical areas were compared to the contralateral cortex using a SUVmax threshold value of 10%; the SUVmax values of GMH lesions were compared with that of the right precentral gyrus. The cortex or GMH with hypometabolism on 18 F-FDG PET/MRI was considered representative of the EZ. The clinical EZ was identified using EEG and semiology. RESULTS Thirty patients (19 PNH; 11 SCH) with a mean age of 28.46 ± 9.52 years were enrolled. The heterotopic nodules were ametabolic in 3 patients (10%), hypometabolic in 16 (33.33%), isometabolic in 13 (26.66%), and hypermetabolic in 4 (10%). 18 F-FDG PET/MRI demonstrated hypometabolism in the cortex and GMH in 22/30 (73.33%) and 16/30 (53.33%). We could identify a clinical EZ in 18 patients, and 15 out of 18 (83.33%) had concordant 18 F-FDG PET/MRI findings. CONCLUSION Heterotopic nodules in GMH patients show different metabolic patterns on 18 F-FDG PET/MRI, with nearly three-quarters of the patients having cortical hypometabolism. 18 F-FDG PET/ MRI findings are mostly concordant with the clinical EZ.
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Affiliation(s)
- Ceren Alis
- Cerrahpasa School of Medicine, Department of Neurology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Deniz Alis
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Lebriz Uslu Besli
- Cerrahpasa School of Medicine, Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ercan Karaarslan
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Kerim Sonmezoglu
- Cerrahpasa School of Medicine, Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cigdem Ozkara
- Cerrahpasa School of Medicine, Department of Neurology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Seher Naz Yeni
- Cerrahpasa School of Medicine, Department of Neurology, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Guo R, Jin L, Dou W, Liu L, Cui R. An Independent Seizure-Onset Zone in Medial Temporal Lobe Found by 18 F-FDG PET Imaging Besides Epileptogenic Periventricular Nodular Heterotopia. Clin Nucl Med 2022; 47:841-842. [PMID: 35619208 DOI: 10.1097/rlu.0000000000004283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 23-year-old man with drug-resistant epilepsy was admitted for presurgical evaluation. The epileptogenic zone could not be derived from seizure semiology and scalp electroencephalographic monitoring definitely. MRI showed periventricular nodular heterotopia in occipital horn of left lateral ventricle with high FDG uptake on interictal 18 F-FDG PET scan, whereas the hypometabolic zone in the left medial temporal lobe was also found on PET with no abnormality on MRI. Stereoelectroencephalographic implantation was performed to identify the seizure-onset zone. Two independent epileptogenic foci located in periventricular nodular heterotopia and left hippocampus were validated by stereoelectroencephalographic monitoring and the outcome of subsequent thermocoagulation.
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Affiliation(s)
- Ruijie Guo
- From the Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Center for Rare Diseases Research, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine
| | | | | | - Linwen Liu
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruixue Cui
- From the Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Center for Rare Diseases Research, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine
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Bund C, Hirsch MPV, Ollivier I, Hirsch E, Namer IJ. Three Different FDG Patterns in Periventricular Nodular Heterotopia Correlated to Video Stereoelectroencephalography. Clin Nucl Med 2021; 46:586-588. [PMID: 33661202 DOI: 10.1097/rlu.0000000000003573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 40-year-old woman with a drug-resistant focal epilepsy underwent cerebral FDG PET in phase 1 presurgical epilepsy study. MRI essentially showed multiple periventricular nodular heterotopias. The stereoelectroencephalography coupled to MRI and FDG PET helped to define the anatomofunctional correlation of the epileptogenic zone network. This procedure brought to light 3 distinct patterns of FDG consumption, corresponding to different anatomoelectroclinical features. This pattern was already found in a previous FDG PET reflecting a "stable" permanent intralesional intercritical stereoelectroencephalography activity, an electrical "signature" of the lesion. Finally, functional imaging improved thermocoagulation in this patient and emphasized the use of FDG in drug-resistant epilepsy.
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Affiliation(s)
| | | | - Irène Ollivier
- Service de Neurochirurgie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Edouard Hirsch
- Service de Neurologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourgand
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Khoo HM, Gotman J, Hall JA, Dubeau F. Treatment of Epilepsy Associated with Periventricular Nodular Heterotopia. Curr Neurol Neurosci Rep 2020; 20:59. [PMID: 33123826 DOI: 10.1007/s11910-020-01082-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Epilepsy associated with periventricular nodular heterotopia (PNH), a developmental malformation, is frequently drug-resistant and requires focal therapeutic intervention. Invasive EEG study is usually necessary to delineate the epileptogenic zone, but constructing an accurate hypothesis to define an appropriate electrode implantation scheme and the treatment is challenging. This article reviews recent studies that help understanding the epileptogenicity and potential therapeutic options in PNH. RECENT FINDINGS New noninvasive diagnostic and intracerebral EEG analytic tools demonstrated that cortical hyperexcitability and aberrant connectivity (between nodules and cortices and among nodules) are likely mechanisms causing epilepsy in most patients. The deeply seated PNH, if epileptogenic, are ideal target for stereotactic ablative techniques, which offer concomitant ablation of multiple regions with relatively satisfactory seizure outcome. Advance in diagnostic and analytic tools have enhanced our understanding of the complex epileptogenicity in PNH. Development in stereotactic ablative techniques now offers promising therapeutic options for these patients.
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Affiliation(s)
- Hui Ming Khoo
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-shi, Osaka Prefecture, 565-0871, Japan.
| | - Jean Gotman
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC, H3A 2B4, Canada
| | - Jeffery A Hall
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC, H3A 2B4, Canada
| | - François Dubeau
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, 3801 University Street, Montreal, QC, H3A 2B4, Canada
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Huang Y, Li Q, Yang Q, Huang Z, Gao H, Xu Y, Liao L. WITHDRAWN: Analysis of Risk Factors for Prognosis and Infection of Child with Refractory Epilepsy Via Artificial Intelligence Neural Network Image Information. Neurosci Lett 2020:S0304-3940(20)30468-7. [PMID: 32585258 DOI: 10.1016/j.neulet.2020.135198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/14/2020] [Accepted: 06/21/2020] [Indexed: 01/08/2023]
Abstract
This article has been withdrawn at the request of the Editor-in-Chief. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Yueyan Huang
- Department of Pediatrics, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, 533000, Guangxi, China
| | - Qingfeng Li
- Department of Radiology, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, 533000, Guangxi, China.
| | - Qian Yang
- Center for Diagnosis and Research of Pathological Diseases, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, 533000, Guangxi, China
| | - Zhijing Huang
- Department of Pediatrics, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, 533000, Guangxi, China
| | - Hongbo Gao
- Department of Pediatrics, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, 533000, Guangxi, China
| | - Yunan Xu
- Department of Pediatrics, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, 533000, Guangxi, China
| | - Lianghua Liao
- Department of Pediatrics, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, 533000, Guangxi, China
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Zhao R, Xue P, Zhou Y, Yang H, Zhou S, Wang Y, Li H. Application of Robot-Assisted Frameless Stereoelectroencephalography Based on Multimodal Image Guidance in Pediatric Refractory Epilepsy: Experience of a Pediatric Center in a Developing Country. World Neurosurg 2020; 140:e161-e168. [PMID: 32389862 DOI: 10.1016/j.wneu.2020.04.218] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To introduce the application of robot-assisted frameless stereoelectroencephalography (SEEG) based on multimodal image fusion technology in pediatric refractory epilepsy in a pediatric center from a developing country. METHODS We retrospectively evaluated pediatric patients with drug-resistant epilepsy who underwent SEEG monitoring at the Children's Hospital of Fudan University from July 2014 to August 2017. Application of multimodal image fusion technology in SEEG was described in detail. Seizure outcomes were assessed according to the International League Against Epilepsy classification. RESULTS A total of 208 patients were initially eligible and underwent a rigorous phase I evaluation. SEEG explorations were performed in 20 patients who entered phase II assessment (11 male and 9 female patients) with a median age of 7.99 ± 4.07 years. In total, 181 electrodes were implanted (9 per implantation), among which 16 implantations were unilateral (6 left and 10 right) and 4 were bilateral. The mean operating time was 3 hours and no obvious hemorrhage occurred. Electrode displacement and pneumocephalus were observed in 1 and 2 patients, respectively. Thirteen and 7 patients underwent tailored resection and radiofrequency thermocoagulation, respectively. Among resection cases, focal cortical dysplasia was the predominant pathologic type. The overall seizure outcome after a mean follow-up of 2.65 years was International League Against Epilepsy class 1 in 13, class 2 in 2, class 3 in 3, class 4 in 1, and class 5 in 1 patient, respectively. CONCLUSIONS The combination of multimodal image fusion and frameless robot-assisted SEEG is demonstrated to be safe and effective on children with refractory epilepsy in developing countries.
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Affiliation(s)
- Rui Zhao
- Department of Neurosurgery, Children's Hospital of Fudan University, Shanghai, P.R China
| | - Ping Xue
- Department of Neurosurgery, Children's Hospital of Fudan University, Shanghai, P.R China
| | - Yuanfeng Zhou
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, P.R China
| | - Haowei Yang
- Department of Radiology, Children's Hospital of Fudan University, Shanghai, P.R China
| | - Shuizhen Zhou
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, P.R China
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, P.R China
| | - Hao Li
- Department of Neurosurgery, Children's Hospital of Fudan University, Shanghai, P.R China.
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Popescu CE, Mai R, Sara R, Lizio D, Zanni D, Rossetti C, Caobelli F. The Role of FDG-PET in Patients with Epilepsy Related to Periventricular Nodular Heterotopias: Diagnostic Features and Long-Term Outcome. J Neuroimaging 2019; 29:512-520. [PMID: 31006947 DOI: 10.1111/jon.12620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Periventricular nodular heterotopias (PNHs) are frequently associated with drug-resistant epilepsy (DRE). Although magnetic resonance imaging (MRI) can define the morphological features of PNHs, still there is a need to assess their metabolic activity in order to provide useful information on epileptogenicity and long-term outcome. To that end, we investigated the ability of 18 F-FDG PET to identify seizure onset zone in order to assess the metabolic activity of the ectopic neurons and to provide prognostic information on the postsurgical outcome. METHODS Sixteen patients (6 men and 10 women; ranging between 24 and 53 years of age) with PNHs-related DRE were evaluated. All patients underwent clinical evaluation, Stereo-electroencephalogram (SEEG), brain MRI, and 18 F-FDG brain PET/CT. PET images were superimposed on the patient-specific 3-dimensional-brain MRI. The metabolic activity of each nodule and of their cortex was visually and semiquantitatively assessed. The outcome after intervention was assessed in all patients using Engel classification. RESULTS Thirty-one heterotopic sites were identified. Twenty-one of 23 nodules with detectable electric activity on SEEG were identified by PET (91.3%), while 5 of 8 of nodules without electric activity showed no metabolism on PET (62.5%). Overall, the concordance between SEEG and FDG-PET was 26/31 (83.9%). Furthermore, cortical metabolic alterations were depicted, correlating with epileptogenic areas. A favorable postsurgical outcome was reported in 13 patients (81.3%). The presence of a hypometabolic nodule significantly correlated with a worse outcome after surgical therapy (P = .036). CONCLUSIONS In PNHs-related epilepsy, FDG-PET more accurately identifies epileptogenic foci, which aids surgical planning and in postoperative seizure control.
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Affiliation(s)
| | - Roberto Mai
- Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Roberto Sara
- Nuclear Medicine Department, Niguarda Hospital, Milan, Italy
| | | | - Daniela Zanni
- Medical Physics Unit, Niguarda Hospital, Milan, Italy
| | | | - Federico Caobelli
- Clinic of Radiology & Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
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Raza HK, Chen H, Chansysouphanthong T, Zhang Z, Hua F, Ye X, Zhang W, Dong L, Zhang S, Wang X, Cui G. The clinical and imaging features of gray matter heterotopia: a clinical analysis on 15 patients. Neurol Sci 2018; 40:489-494. [PMID: 30535564 DOI: 10.1007/s10072-018-3667-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/28/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the clinical and imaging features of gray matter heterotopia (GMH) and improve the clinicians' understanding of the disease. METHODS A retrospective study was performed on 15 patients with GMH diagnosed at The Affiliated Hospital of Xuzhou Medical University from November 2014 to November 2016. Their clinical and imaging features are also summarized. RESULTS The proportion of male and female patients was 2:1. The age of onset was 2~45 years and the average age was 19.1 years. There were 13 patients with epilepsy who also had cognitive decline (5 cases) and neurological deficit (3 cases). There were 2 patients with headache or dizziness. The imaging findings of GMH are unilateral or multiple spots in the periventricular or subependymal, subcortical, and centrum semiovale and are often accompanied by other cerebral malformations. We found that 10 patients had the subcortical type of GMH and 5 patients had the subependymal type or periventricular nodular heterotopia type. There were 8 cases of ventricular compression, 5 cases of ventriculomegaly, 5 cases of cerebral fissure malformation, 3 cases of pachygyria, 1 case of callosal agenesis, and 1 case of undeveloped septum pellucidum. All the patients were given symptomatic and supportive therapies and 3 patients were treated with antiepileptic drugs. Seizures were, however, poorly controlled. CONCLUSION GMH should also be suspected in patients with juvenile onset of seizures, cognitive decline, and neurological deficits. Magnetic resonance scans may show lesions in the white matter of the brain with signals similar to the normal gray matter.
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Affiliation(s)
- Hafiz Khuram Raza
- School of International Education, Xuzhou Medical University, Xuzhou, 221004, China.,Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Hao Chen
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.
| | | | - Zuohui Zhang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Fang Hua
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Xinchun Ye
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Wei Zhang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Liguo Dong
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Shenyang Zhang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Xiaopeng Wang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Guiyun Cui
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.
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Nagesh C, Kumar S, Menon R, Thomas B, Radhakrishnan A, Kesavadas C. The Imaging of Localization Related Symptomatic Epilepsies: The Value of Arterial Spin Labelling Based Magnetic Resonance Perfusion. Korean J Radiol 2018; 19:965-977. [PMID: 30174487 PMCID: PMC6082755 DOI: 10.3348/kjr.2018.19.5.965] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/19/2018] [Indexed: 11/15/2022] Open
Abstract
Accurate identification of the epileptogenic zone is an important prerequisite in presurgical evaluation of refractory epilepsy since it affects seizure-free outcomes. Apart from structural magnetic resonance imaging (sMRI), delineation has been traditionally done with electroencephalography and nuclear imaging modalities. Arterial spin labelling (ASL) sequence is a non-contrast magnetic resonance perfusion technique capable of providing similar information. Similar to single-photon emission computed tomography, its utility in epilepsy is based on alterations in perfusion linked to seizure activity by neurovascular coupling. In this article, we discuss complementary value that ASL can provide in the evaluation and characterization of some basic substrates underlying epilepsy. We also discuss the role that ASL may play in sMRI negative epilepsy and acute scenarios such as status epilepticus.
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Affiliation(s)
- Chinmay Nagesh
- Department of Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
| | - Savith Kumar
- Department of Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
| | - Ramshekhar Menon
- Comprehensive Epilepsy Centre, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
| | - Bejoy Thomas
- Department of Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
| | - Ashalatha Radhakrishnan
- Comprehensive Epilepsy Centre, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
| | - Chandrasekharan Kesavadas
- Department of Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum 695011, India
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