Yield of MRI, high-density electric source imaging (HD-ESI), SPECT and PET in epilepsy surgery candidates

Abstract

This finding highlights the added value of HD-ESI in the presurgical workup, in particular in combination with an informative MRI.

Imaging epileptogenic brain using high density EEG source imaging and MRI

“…They have shown an OR value of 10 for (HD-ESI + MRI) and an OR value of 7 for (SPECT + MRI). These results clearly show the power of combined MRI and HD-ESI in predicting seizure outcome and can serve as the first two modalities to be considered for diagnosis and treatment planning (Lascano et al, 2015).…”

“…OR intuitively depicts the predictive value of a modality, which shows how the results from that modality are predictive in determining seizure-free outcomes. It was shown that HD-ESI and MRI had high OR values (2 times that of SPECT or PET): the OR value for HD-ESI, MRI, SPECT and PET were found to be 6.4, 5.8, 2.8 and 2.8, respectively (Lascano et al, 2015).…”

“…In this issue of Clinical Neurophysiology, Lascano et al (2015) have looked into this important question in a study of 190 epilepsy patients. The value of each modality in determining seizure-free outcome has been statistically assessed by comparing the epileptogenic zones estimates from each modality with the resection volume.…”

“…Most studies using noninvasive modalities have involved small number of patients due to the challenges involved in comparing estimation results obtained by such modalities with invasive recordings and surgical resection outcomes, in patient populations. In the present issue, Lascano et al (2015) report encouraging results in 190 operated patients using electrical source imaging (ESI), magnetic resonance imaging (MRI), Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) (Lascano et al, 2015). It represents an important advance in furthering our efforts to establish noninvasive neuroimaging for aiding presurgical planning in partial epilepsy.…”

Multimodal investigation of epileptic networks

“…Patients can thus be EEG-video monitored and injected at the time of a relevant brain activity (ideally seizure onset) as seen on the EEG traces. It is generally agreed that the use of SPECT during interictal brain state is of limited use (Debets et al, 1997;Lascano et al, 2015;Spencer, 1994). In contrast, SPECT is mostly useful when the radioligand is injected at seizure initiation (Joo et al, 2004;Spencer, 1994).…”