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Subcortical SISCOM hyperperfusion: Should we pay more attention to it?

Jerome Aupy1, Sattawut Wongwiangjunt2, Zhong I Wang3

  • 1Cleveland Clinic, Neurological Institute, Epilepsy Center, Cleveland, OH, 44195, USA; CHU of Bordeaux, Pole de Neurosciences Cliniques, Bordeaux, France; University of Bordeaux, IMN, UMR-CNRS 5293, Bordeaux, France.

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Subcortical hyperperfusion detected by ictal-interictal SPECT with co-registration to MRI (SISCOM) can help lateralize the seizure focus. Basal ganglia and cerebellar coactivation showed the highest predictive value for seizure side localization.

Keywords:
Basal gangliaCerebellumEpilepsySISCOMSPECTSeizuresThalamus

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Area of Science:

  • Neuroimaging
  • Epilepsy Surgery
  • Functional Neuroanatomy

Background:

  • Ictal-ictal SPECT with co-registration to MRI (SISCOM) visualizes cerebral blood flow changes during seizures.
  • Understanding subcortical hyperperfusion patterns is crucial for localizing seizure origins, especially in focal epilepsy.

Purpose of the Study:

  • To investigate subcortical ictal hyperperfusion patterns in focal seizures using SISCOM.
  • To evaluate the relationship between the epileptogenic zone and subcortical hyperperfusion in patients who achieved seizure freedom after surgery.

Main Methods:

  • Retrospective analysis of SISCOM data from 67 patients seizure-free for at least one year post-resection.
  • Blind review of SISCOM for basal ganglia (BG), thalamic (TN), and cerebellar (CH) hyperperfusion at various thresholds.
  • Calculation of sensitivity, specificity, and predictive values for correct epilepsy side lateralization.

Main Results:

  • Subcortical hyperperfusion varied by region and threshold: BG (37.3-73.9%), TN (31.3-68.1%), CH (13.5-29%).
  • Optimal lateralization was achieved with BG/CH coactivation (89% positive predictive value) at a threshold of 1.5.
  • BG/TN coactivation (88%) and BG activation (82%) were optimal at thresholds of 2.0 and 2.5, respectively.

Conclusions:

  • Subcortical hyperperfusion patterns identified by SISCOM provide valuable information for seizure lateralization.
  • SISCOM analysis, particularly involving basal ganglia and thalamus/cerebellum, can aid in refining the localization of the epileptogenic zone.