Ictal SPECT statistical parametric mapping in temporal lobe epilepsy surgery

N. J. Kazemi, Gregory Alan Worrell, Squire Matthew Stead, Benjamin Brinkmann, B. P. Mullan, T. J. O'Brien, E. L. So

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

OBJECTIVE: Although subtraction ictal SPECT coregistered to MRI (SISCOM) is clinically useful in epilepsy surgery evaluation, it does not determine whether the ictal-interictal subtraction difference is statistically different from the expected random variation between 2 SPECT studies. We developed a statistical parametric mapping and MRI voxel-based method of analyzing ictal-interictal SPECT difference data (statistical ictal SPECT coregistered to MRI [STATISCOM]) and compared it with SISCOM. METHODS: Two serial SPECT studies were performed in 11 healthy volunteers without epilepsy (control subjects) to measure random variation between serial studies from individuals. STATISCOM and SISCOM images from 87 consecutive patients who had ictal SPECT studies and subsequent temporal lobectomy were assessed by reviewers blinded to clinical data and outcome. RESULTS: Interobserver agreement between blinded reviewers was higher for STATISCOM images than for SISCOM images (κ = 0.81 vs κ = 0.36). STATISCOM identified a hyperperfusion focus in 84% of patients, SISCOM in 66% (p < 0.05). STATISCOM correctly localized the temporal lobe epilepsy (TLE) subtypes (mesial vs lateral neocortical) in 68% of patients compared with 24% by SISCOM (p = 0.02); subgroup analysis of patients without lesions (as determined by MRI) showed superiority of STATISCOM (80% vs 47%; p = 0.04). Moreover, the probability of seizure-free outcome was higher when STATISCOM correctly localized the TLE subtype than when it was indeterminate (81% vs 53%; p = 0.03). CONCLUSION: Statistical ictal SPECT coregistered to MRI (STATISCOM) was superior to subtraction ictal SPECT coregistered to MRI for seizure localization before temporal lobe epilepsy (TLE) surgery. STATISCOM localization to the correct TLE subtype was prognostically important for postsurgical seizure freedom.

Original languageEnglish (US)
Pages (from-to)70-76
Number of pages7
JournalNeurology
Volume74
Issue number1
DOIs
StatePublished - Jan 2010

Fingerprint

Temporal Lobe Epilepsy
Single-Photon Emission-Computed Tomography
Stroke
Seizures
Epilepsy

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Ictal SPECT statistical parametric mapping in temporal lobe epilepsy surgery. / Kazemi, N. J.; Worrell, Gregory Alan; Stead, Squire Matthew; Brinkmann, Benjamin; Mullan, B. P.; O'Brien, T. J.; So, E. L.

In: Neurology, Vol. 74, No. 1, 01.2010, p. 70-76.

Research output: Contribution to journalArticle

@article{8c1b6d8f2d0f48239154329ad4a5d544,
title = "Ictal SPECT statistical parametric mapping in temporal lobe epilepsy surgery",
abstract = "OBJECTIVE: Although subtraction ictal SPECT coregistered to MRI (SISCOM) is clinically useful in epilepsy surgery evaluation, it does not determine whether the ictal-interictal subtraction difference is statistically different from the expected random variation between 2 SPECT studies. We developed a statistical parametric mapping and MRI voxel-based method of analyzing ictal-interictal SPECT difference data (statistical ictal SPECT coregistered to MRI [STATISCOM]) and compared it with SISCOM. METHODS: Two serial SPECT studies were performed in 11 healthy volunteers without epilepsy (control subjects) to measure random variation between serial studies from individuals. STATISCOM and SISCOM images from 87 consecutive patients who had ictal SPECT studies and subsequent temporal lobectomy were assessed by reviewers blinded to clinical data and outcome. RESULTS: Interobserver agreement between blinded reviewers was higher for STATISCOM images than for SISCOM images (κ = 0.81 vs κ = 0.36). STATISCOM identified a hyperperfusion focus in 84{\%} of patients, SISCOM in 66{\%} (p < 0.05). STATISCOM correctly localized the temporal lobe epilepsy (TLE) subtypes (mesial vs lateral neocortical) in 68{\%} of patients compared with 24{\%} by SISCOM (p = 0.02); subgroup analysis of patients without lesions (as determined by MRI) showed superiority of STATISCOM (80{\%} vs 47{\%}; p = 0.04). Moreover, the probability of seizure-free outcome was higher when STATISCOM correctly localized the TLE subtype than when it was indeterminate (81{\%} vs 53{\%}; p = 0.03). CONCLUSION: Statistical ictal SPECT coregistered to MRI (STATISCOM) was superior to subtraction ictal SPECT coregistered to MRI for seizure localization before temporal lobe epilepsy (TLE) surgery. STATISCOM localization to the correct TLE subtype was prognostically important for postsurgical seizure freedom.",
author = "Kazemi, {N. J.} and Worrell, {Gregory Alan} and Stead, {Squire Matthew} and Benjamin Brinkmann and Mullan, {B. P.} and O'Brien, {T. J.} and So, {E. L.}",
year = "2010",
month = "1",
doi = "10.1212/WNL.0b013e3181c7da20",
language = "English (US)",
volume = "74",
pages = "70--76",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Ictal SPECT statistical parametric mapping in temporal lobe epilepsy surgery

AU - Kazemi, N. J.

AU - Worrell, Gregory Alan

AU - Stead, Squire Matthew

AU - Brinkmann, Benjamin

AU - Mullan, B. P.

AU - O'Brien, T. J.

AU - So, E. L.

PY - 2010/1

Y1 - 2010/1

N2 - OBJECTIVE: Although subtraction ictal SPECT coregistered to MRI (SISCOM) is clinically useful in epilepsy surgery evaluation, it does not determine whether the ictal-interictal subtraction difference is statistically different from the expected random variation between 2 SPECT studies. We developed a statistical parametric mapping and MRI voxel-based method of analyzing ictal-interictal SPECT difference data (statistical ictal SPECT coregistered to MRI [STATISCOM]) and compared it with SISCOM. METHODS: Two serial SPECT studies were performed in 11 healthy volunteers without epilepsy (control subjects) to measure random variation between serial studies from individuals. STATISCOM and SISCOM images from 87 consecutive patients who had ictal SPECT studies and subsequent temporal lobectomy were assessed by reviewers blinded to clinical data and outcome. RESULTS: Interobserver agreement between blinded reviewers was higher for STATISCOM images than for SISCOM images (κ = 0.81 vs κ = 0.36). STATISCOM identified a hyperperfusion focus in 84% of patients, SISCOM in 66% (p < 0.05). STATISCOM correctly localized the temporal lobe epilepsy (TLE) subtypes (mesial vs lateral neocortical) in 68% of patients compared with 24% by SISCOM (p = 0.02); subgroup analysis of patients without lesions (as determined by MRI) showed superiority of STATISCOM (80% vs 47%; p = 0.04). Moreover, the probability of seizure-free outcome was higher when STATISCOM correctly localized the TLE subtype than when it was indeterminate (81% vs 53%; p = 0.03). CONCLUSION: Statistical ictal SPECT coregistered to MRI (STATISCOM) was superior to subtraction ictal SPECT coregistered to MRI for seizure localization before temporal lobe epilepsy (TLE) surgery. STATISCOM localization to the correct TLE subtype was prognostically important for postsurgical seizure freedom.

AB - OBJECTIVE: Although subtraction ictal SPECT coregistered to MRI (SISCOM) is clinically useful in epilepsy surgery evaluation, it does not determine whether the ictal-interictal subtraction difference is statistically different from the expected random variation between 2 SPECT studies. We developed a statistical parametric mapping and MRI voxel-based method of analyzing ictal-interictal SPECT difference data (statistical ictal SPECT coregistered to MRI [STATISCOM]) and compared it with SISCOM. METHODS: Two serial SPECT studies were performed in 11 healthy volunteers without epilepsy (control subjects) to measure random variation between serial studies from individuals. STATISCOM and SISCOM images from 87 consecutive patients who had ictal SPECT studies and subsequent temporal lobectomy were assessed by reviewers blinded to clinical data and outcome. RESULTS: Interobserver agreement between blinded reviewers was higher for STATISCOM images than for SISCOM images (κ = 0.81 vs κ = 0.36). STATISCOM identified a hyperperfusion focus in 84% of patients, SISCOM in 66% (p < 0.05). STATISCOM correctly localized the temporal lobe epilepsy (TLE) subtypes (mesial vs lateral neocortical) in 68% of patients compared with 24% by SISCOM (p = 0.02); subgroup analysis of patients without lesions (as determined by MRI) showed superiority of STATISCOM (80% vs 47%; p = 0.04). Moreover, the probability of seizure-free outcome was higher when STATISCOM correctly localized the TLE subtype than when it was indeterminate (81% vs 53%; p = 0.03). CONCLUSION: Statistical ictal SPECT coregistered to MRI (STATISCOM) was superior to subtraction ictal SPECT coregistered to MRI for seizure localization before temporal lobe epilepsy (TLE) surgery. STATISCOM localization to the correct TLE subtype was prognostically important for postsurgical seizure freedom.

UR - http://www.scopus.com/inward/record.url?scp=74049100181&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=74049100181&partnerID=8YFLogxK

U2 - 10.1212/WNL.0b013e3181c7da20

DO - 10.1212/WNL.0b013e3181c7da20

M3 - Article

C2 - 20038775

AN - SCOPUS:74049100181

VL - 74

SP - 70

EP - 76

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 1

ER -