SISCOM in children with tuberous sclerosis complex-related epilepsy

Area of Science:

• Neurology
• Pediatric Epilepsy Surgery
• Neuroimaging

Background:

• Tuberous sclerosis complex (TSC) often presents with intractable epilepsy due to multifocal brain abnormalities.
• Identifying the dominant epileptogenic focus in TSC is challenging, hindering effective surgical intervention.
• Noninvasive neuroimaging, such as SISCOM, is explored to localize seizure foci.

Purpose of the Study:

• To evaluate the correlation between complete resection of SISCOM hyperperfusion abnormalities and seizure-free outcomes in pediatric TSC patients.
• To assess the utility of SISCOM in guiding epilepsy surgery in children with TSC and multifocal tubers.
• To determine if SISCOM provides crucial localizing information when other diagnostic methods are inconclusive.

Main Methods:

• Retrospective analysis of 6 children with TSC-related epilepsy undergoing epilepsy surgery.
• Utilized subtraction ictal single-photon emission computed tomography coregistered to magnetic resonance imaging (SISCOM) to identify hyperperfusion foci.
• Assessed seizure outcomes at a minimum 2-year follow-up post-resection of identified SISCOM abnormalities.

Main Results:

• A dominant SISCOM hyperperfusion focus was identified in 5 out of 6 patients.
• SISCOM offered additional localizing data in 3 patients with nonlocalizing or discordant findings.
• Three patients achieved seizure freedom, with 2 showing association between complete SISCOM abnormality resection and seizure freedom.

Conclusions:

• SISCOM is a valuable tool for identifying the epileptogenic zone in pediatric TSC patients.
• Complete resection of SISCOM-identified hyperperfusion abnormalities is associated with seizure freedom in TSC-related epilepsy.
• SISCOM aids in guiding the surgical approach for epilepsy in children with TSC and complex imaging findings.