Relation of Brain Perfusion Patterns to Sudden Unexpected Death Risk Stratification: A Study in Drug Resistant Focal...

Area of Science:

• Neuroimaging
• Epilepsy Research
• Biomarker Discovery

Background:

• Drug-resistant focal epilepsy (DRFE) poses significant challenges in patient management.
• Sudden Unexpected Death in Epilepsy (SUDEP) remains a critical concern, necessitating improved risk stratification methods.
• Functional neuroimaging, specifically SPECT, offers potential for identifying biomarkers related to SUDEP risk.

Purpose of the Study:

• To investigate the utility of interictal and ictal SPECT scans in identifying functional neuroimaging biomarkers for SUDEP risk stratification in DRFE patients.
• To correlate cerebral blood flow patterns with SUDEP risk using advanced data analysis techniques.

Main Methods:

• Acquired and analyzed 29 interictal-ictal SPECT scans from nine DRFE patients.
• Quantified relative cerebral blood flow in 74 cortical and sub-cortical structures using K-means clustering.
• Employed data mining for automatic feature selection to identify structures related to SUDEP-7 inventory scores.

Main Results:

• Identified hyperperfused regions including bilateral rectus gyrus, putamen, and ipsilateral globus pallidus.
• Identified hypoperfused regions such as the red nucleus, substantia nigra, medulla, and entorhinal area.
• Observed nearly invariable perfusion patterns in the ipsilateral putamen, entorhinal area, and middle temporal gyrus during the interictal to ictal transition, suggesting potential SUDEP biomarkers.

Conclusions:

• The study successfully identified hypo- and hyperperfused brain regions associated with SUDEP risk in DRFE patients.
• Consistent perfusion changes in specific brain areas during the interictal-ictal transition may serve as valuable biomarkers for SUDEP risk stratification.
• These findings contribute to a better understanding of the neurobiological underpinnings of SUDEP and inform clinical risk assessment.