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Related Experiment Video

Updated: Jun 27, 2025

Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
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SPECT postprocessing for epileptogenic focus localization: SISCOM versus ISAS.

Nicole van Klink1, Tineke Gebbink1, Cyrille Ferrier1

  • 1Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, UMC Utrecht, Utrecht, The Netherlands.

Epilepsia Open
|May 3, 2024
PubMed
Summary
This summary is machine-generated.

Ictal-interictal SPECT analyzed by SPM (ISAS) provides comparable or better results than SISCOM for identifying the epileptogenic zone in epilepsy surgery candidates. ISAS offers improved interpretability and is a reliable alternative for clinical use.

Keywords:
ISASSISCOMSPECTepilepsy surgerynormal database

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Area of Science:

  • Neurology
  • Medical Imaging
  • Epileptology

Background:

  • Ictal single-photon emission computed tomography (SPECT) is crucial for estimating the epileptogenic zone in focal epilepsy.
  • Subtraction of ictal and interictal SPECT scans identifies hyperperfused areas, but physiological variance correction is challenging.
  • Scanner-specific control databases are ideal but difficult to obtain due to ethical concerns.

Purpose of the Study:

  • To compare the effectiveness of Ictal-Interictal SPECT analyzed by SPM (ISAS) with Subtraction Ictal SPECT Co-registered to MRI (SISCOM).
  • To evaluate ISAS using a publicly available control database as an alternative to SISCOM for epilepsy surgery workup.

Main Methods:

  • Retrospective analysis of SPECT scans from 26 focal drug-resistant epilepsy patients (7-50 years).
  • Comparison of SISCOM and ISAS algorithms using a publicly available control database for ISAS.
  • Blinded reviewer assessment of ictal hyperperfusion location and comparison with resected areas or suspected epileptogenic zones.

Main Results:

  • ISAS and SISCOM identified the same hyperperfusion location in 54% of patients.
  • ISAS localized hyperperfusion in 6 additional patients where SISCOM did not.
  • ISAS demonstrated higher accuracy (65% vs. 55%) and better localization of maximum hyperperfusion (65% vs. 38%) compared to SISCOM.

Conclusions:

  • ISAS, utilizing a public control database, offers comparable or superior results to SISCOM for identifying the epileptogenic zone.
  • ISAS provides more interpretable results and is a reliable, easily implementable alternative for epilepsy surgery clinics.
  • ISAS is a promising option, particularly for centers lacking specific control SPECT datasets.