scholarly journals Use of Innovative SPECT Techniques in the Presurgical Evaluation of Patients with Nonlesional Extratemporal Drug-Resistant Epilepsy

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Ahmed Yassin ◽  
Khalid El-Salem ◽  
Abdel-Hameed Al-Mistarehi ◽  
Aiman Momani ◽  
Anas M. Zein Alaabdin ◽  
...  
Keyword(s):  
Single Photon ◽  
Photon Emission ◽  
Vital Role ◽  
Emission Computed Tomography ◽  
Drug Resistant ◽  
Presurgical Evaluation ◽  
Ictal Spect ◽  
Seizure Onset Zone ◽  
Drug Resistant Epilepsy ◽  
Patients With Epilepsy

Up to 30% of patients with epilepsy may not respond to antiepileptic drugs. Patients with drug-resistant epilepsy (DRE) should undergo evaluation for seizure onset zone (SOZ) localization to consider surgical treatment. Cases of drug-resistant nonlesional extratemporal lobe epilepsy (ETLE) pose the biggest challenge in localizing the SOZ and require multiple noninvasive diagnostic investigations before planning the intracranial monitoring (ICM) or direct resection. Ictal Single Photon Emission Computed Tomography (i-SPECT) is a unique functional diagnostic tool that assesses the SOZ using the localized hyperperfusion that occurs early in the seizure. Subtraction ictal SPECT coregistered to MRI (SISCOM), statistical ictal SPECT coregistered to MRI (STATISCOM), and PET interictal subtracted ictal SPECT coregistered with MRI (PISCOM) are innovative SPECT methods for the determination of the SOZ. This article comprehensively reviews SPECT and sheds light on its vital role in the presurgical evaluation of the nonlesional extratemporal DRE.

The Role of Magnetoencephalography and Single-Photon Emission Computed Tomography in Evaluation of Children With Drug-Resistant Epilepsy

2021 ◽  
pp. 088307382199655
Author(s):  
Benjamin D. Edmonds ◽  
William Welch ◽  
Yoshimi Sogawa ◽  
James Mountz ◽  
Anto Bagić ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Drug Resistant ◽  
Single Photon Emission ◽  
Presurgical Evaluation ◽  
Single Photon Emission Computed ◽  
Drug Resistant Epilepsy ◽  
Photon Emission Computed Tomography

Surgery holds the best outcomes for drug-resistant epilepsy in children, making localization of a seizure focus essential. However, there is limited research on the contribution of magnetoencephalography and single-photon emission computed tomography (SPECT) to the presurgical evaluation of lesional and nonlesional pediatric patients. This study proposed to evaluate the concordance of SPECT and magnetoencephalography (MEG) to scalp electroencephalography (EEG) to determine their effective contribution to the presurgical evaluation. On review, MEG and SPECT studies for 28 drug-resistant epilepsy cases were completed at Children’s Hospital of Pittsburgh from May 2012 to August 2018. Although not reaching statistical significance, MEG had increased lobar concordance with EEG compared with SPECT (68% vs 46%). MEG or SPECT results effectively provided localization data leading to 6 surgical evaluations and 3 resections with outcomes of Engel class I or II at 12 months. This study suggests MEG and SPECT provide valuable localizing information for presurgical epilepsy evaluation of children with drug-resistant epilepsy.

scholarly journals Evaluating the Development of a SPECT Protocol in a Canadian Epilepsy Unit

2007 ◽  
Vol 34 (2) ◽  
pp. 225-229 ◽  
Author(s):  
J. G. Burneo ◽  
W. Vezina ◽  
J. Romsa ◽  
B. J. Smith ◽  
R. S. McLachlan
Keyword(s):  
Functional Neuroimaging ◽  
Single Photon ◽  
Photon Emission ◽  
Contamination Rate ◽  
Emission Computed Tomography ◽  
Presurgical Evaluation ◽  
Efficient Delivery ◽  
Routine Basis ◽  
Intracranial Electrodes ◽  
Seizure Localization

Background:Functional neuroimaging can address some challenges of seizure localization, and sometimes preclude the need for EEG recording using intracranial electrodes. Ictal Single Photon Emission Computed Tomography (SPECT) has developed into an important tool in the presurgical evaluation of patients with medically-intractable localization-related epilepsy. The purpose of the study was to determine whether the development of a programme using trained nurses to perform ictal injections enabled a more efficient delivery of radiopharmaceuticals and therefore a greater sensitivity and specificity of outcome.Methods:In our epilepsy unit, nursing staff inject 99mTc-HMPAO at bedside, during or at seizure onset. Brain SPECT is performed later on a gamma camera.Results:Since the implementation of the new protocol (February 2005), 57 scans have been performed: 22 ictal and 35 interictal. Latency of ictal injection was found to be 5-40 seconds (mean 19.7 sec, standard deviation (SD) 10.4). Only 20% of reconstituted radiopharmaceutical vials were not used. Contamination rate was nil. Sixty three percent of SPECT studies were concordant with standard presurgical evaluation.Conclusion:The latency of injections and the percentage of unused vials indicated an efficient and effective protocol compared to the literature. Our results show that ictal SPECT can be a safe, noninvasive procedure performed on a routine basis in the epilepsy unit when appropriately trained support staff are incorporated into a structured multidisciplinary programme.

scholarly journals SURGICAL TREATMENT OF MRI-NEGATIVE EPILEPSY (A REVIEW)

2019 ◽  
Vol 21 (2) ◽  
pp. 76-84
Author(s):  
I. S. Trifonov ◽  
O. O. Kordonskaya ◽  
M. V. Sinkin ◽  
E. V. Grigorieva
Keyword(s):  
Surgical Treatment ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Advantages And Disadvantages ◽  
Positron Emission ◽  
Surgical Evaluation ◽  
Evaluation Algorithm ◽  
Drug Resistant Epilepsy ◽  
Definition Of

Removal of epileptogenic lesions is an effective way to treat patients with drug-resistant epilepsy. The result of surgical treatment depends on the correct detection of pathology, definition of its boundaries. No lesion on magnetic resonance imaging is not a contraindication to surgical treatment, but requires a survey. Each of the additional methods has its advantages and disadvantages. Сomprehensive examination, analysis and comparison of positron emission tomography, single-photon emission computed tomography, magnetoencephalography, scalp and invasive electroencephalography data can significantly improve the results of surgical treatment MRI-negative epilepsy patients. Clarification of the pre-surgical evaluation algorithm will allow to optimize the use of techniques.

Utility of Ictal Single Photon Emission Computed Tomography in Mesial Temporal Lobe Epilepsy With Hippocampal Atrophy

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. 431-436 ◽  
Author(s):  
Tonicarlo R. Velasco ◽  
Lauro Wichert-Ana ◽  
Gary W. Mathern ◽  
David Araújo ◽  
Roger Walz ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Single Photon ◽  
Photon Emission ◽  
Mesial Temporal Lobe Epilepsy ◽  
Emission Computed Tomography ◽  
Ictal Spect ◽  
Mesial Temporal Lobe ◽  
Single Photon Emission Computed ◽  
Photon Emission Computed Tomography ◽  
Video Eeg

Abstract BACKGROUND: The development of newer diagnostic technologies has reduced the need for invasive electroencephalographic (EEG) studies in identifying the epileptogenic zone, especially in adult patients with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS). OBJECTIVE: To evaluate ictal single photon emission computed tomography (SPECT) in the evaluation and treatment of patients with MTLE-HS. METHODS: MTLE patients were randomly assigned to those with (SPECT, n = 124) and without ictal SPECT (non-SPECT, n = 116) in an intent-to-treat protocol. Primary end points were the proportion of patients with invasive EEG studies, and those offered surgery. Secondary end points were the length of hospital stay and the proportion of patients with secondarily generalized seizures (SGS) during video-EEG, postsurgical seizure outcome, and hospital cost. RESULTS: The proportion of patients offered surgery was similar in the SPECT (85%) and non-SPECT groups (81%), as well as the proportion that had invasive EEG studies (27% vs 23%). The mean duration of hospital stay was 1 day longer for the SPECT group (P < 0.001). SGS occurred in 51% of the SPECT and 26% of the non-SPECT group (P < 0.001). The cost of the presurgical evaluation was 35% higher for the SPECT compared with the non-SPECT group (P < 0.001). The proportion of patients seizure-free after surgery was similar in the SPECT (59%) compared with non-SPECT group (54%). CONCLUSION: Ictal-SPECT did not add localizing value beyond what was provided by EEG-video telemetry and structural MRI that altered the surgical decision and outcome for MTLE-HS patients. Ictal-SPECT increased hospital stay was associated with increased costs and a higher chance of SGS during video-EEG monitoring. These findings support the notion that a protocol including ictal SPECT is equivalent to one without SPECT in the presurgical evaluation of adult patients with MTLE-HS.

scholarly journals Multimodal Image Integration for Epilepsy Presurgical Evaluation: A Clinical Workflow

2021 ◽  
Vol 12 ◽  
Author(s):  
Liri Jin ◽  
Joon Yul Choi ◽  
Juan Bulacio ◽  
Andreas V. Alexopoulos ◽  
Richard C. Burgess ◽  
...  
Keyword(s):  
Trajectory Planning ◽  
Single Photon ◽  
Focal Cortical Dysplasia ◽  
Photon Emission ◽  
Cleveland Clinic ◽  
Emission Computed Tomography ◽  
Epileptogenic Zone ◽  
Image Integration ◽  
Clinical Workflow ◽  
Presurgical Evaluation

Multimodal image integration (MMII) is a promising tool to help delineate the epileptogenic zone (EZ) in patients with medically intractable focal epilepsies undergoing presurgical evaluation. We report here the detailed methodology of MMII and an overview of the utility of MMII at the Cleveland Clinic Epilepsy Center from 2014 to 2018, exemplified by illustrative cases. The image integration was performed using the Curry platform (Compumedics Neuroscan™, Charlotte, NC, USA), including all available diagnostic modalities such as Magnetic resonance imaging (MRI), Positron Emission Tomography (PET), single-photon emission computed tomography (SPECT) and Magnetoencephalography (MEG), with additional capability of trajectory planning for intracranial EEG (ICEEG), particularly stereo-EEG (SEEG), as well as surgical resection planning. In the 5-year time span, 467 patients underwent MMII; of them, 98 patients (21%) had a history of prior neurosurgery and recurring seizures. Of the 467 patients, 425 patients underwent ICEEG implantation with further CT co-registration to identify the electrode locations. A total of 351 patients eventually underwent surgery after MMII, including 197 patients (56%) with non-lesional MRI and 223 patients (64%) with extra-temporal lobe epilepsy. Among 269 patients with 1-year post-operative follow up, 134 patients (50%) had remained completely seizure-free. The most common histopathological finding is focal cortical dysplasia. Our study illustrates the usefulness of MMII to enhance SEEG electrode trajectory planning, assist non-invasive/invasive data interpretation, plan resection strategy, and re-evaluate surgical failures. Information presented by MMII is essential to the understanding of the anatomo-functional-electro-clinical correlations in individual cases, which leads to the ultimate success of presurgical evaluation of patients with medically intractable focal epilepsies.

Surgical management of epilepsy

2019 ◽  
pp. 957-968
Author(s):  
Johannes Schramm
Keyword(s):  
Surgical Management ◽  
Temporal Lobe ◽  
Single Photon ◽  
Photon Emission ◽  
Hypothalamic Hamartoma ◽  
Emission Computed Tomography ◽  
Palliative Procedure ◽  
Vagal Nerve Stimulator ◽  
Selective Amygdalohippocampectomy ◽  
Drug Resistant Epilepsy

The chapter describes procedures for surgical management of drug-resistant epilepsy. The presurgical evaluation is outlined including the use of MRI, and functional imaging with PET and single photon emission computed tomography (SPECT). The importance of electroencephalographic recordings of seizures in split-screen video technique is underlined. The spectrum of interventions includes temporal lobe procedures (selective amygdalohippocampectomy, two-thirds temporal lobectomy, and tailored lateral resections), in addition to extratemporal lobe resections consisting of lesionectomies, extended lesionectomies, but also lobectomies and multilobectomies. Hemispherectomies/hemispherotomies of various types are described and a second disconnective procedure: callosotomy. Vagal nerve stimulator implantation as a palliative procedure is detailed, and other operations are briefly touched (such as hypothalamic hamartoma disconnection, deep brain stimulation, and responsive cortical stimulator implantation). The chapter is concluded by briefly discussing outcome of epilepsy surgery and management of complications. The controversy concerning small temporal lobe resections versus classic lobe resections is outlined.

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