Influence of subtraction ictal SPECT on surgical management in focal epilepsy of indeterminate localization: A prospective study

K. Meng Tan, Jeffrey W. Britton, Jeffrey R. Buchhalter, Gregory Alan Worrell, Terrence D. Lagerlund, Cheolsu Shin, Gregory D Cascino, Fredric B. Meyer, Elson L. So

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

The impact of functional imaging tests on the decision-making and planning process for epilepsy surgery has never been prospectively assessed. We prospectively evaluated 50 consecutively eligible patients whose noninvasive evaluations showed nonlocalized findings and determined how their SISCOM (subtraction ictal SPECT [single photon emission computed tomography] co-registered to MRI [magnetic resonance imaging]) data altered consensus decisions for epilepsy surgery. At an epilepsy surgery conference where each patient was discussed, consensus decisions were documented after a standardized presentation of data from the noninvasive evaluation (SISCOM findings initially were excluded). Consensus decisions were again documented after presentation of SISCOM data. Consensus decisions changed for 10 of 32 patients (31%) with localizing SISCOM results, whereas the decision changed in only 1 of 18 patients (6%) with nonlocalizing SISCOM results (P < .05). Changes in consensus decisions were as follows: (1) intracranial electrode implantation (IEI) was obviated and resective surgery was recommended (n = 2); (2) resective surgery or further evaluation for patients initially not considered surgical candidates (n = 2); (3) IEI in patients for whom it was not recommended initially (n = 3); (4) increased IEI coverage (n = 3); and (5) antiepileptic drug trial or vagal nerve stimulation was recommended instead of IEI (n = 1). For some patients whose noninvasive evaluations did not clearly localize a surgical focus, SISCOM data can have a major impact on decisions to recommend resective epilepsy surgery or IEI.

Original languageEnglish (US)
Pages (from-to)190-193
Number of pages4
JournalEpilepsy Research
Volume82
Issue number2-3
DOIs
StatePublished - Dec 2008

Fingerprint

Partial Epilepsy
Single-Photon Emission-Computed Tomography
Stroke
Prospective Studies
Consensus
Electrodes
Epilepsy
Vagus Nerve Stimulation
Anticonvulsants
Decision Making
Magnetic Resonance Imaging

Keywords

  • Epilepsy surgery
  • Seizures
  • SISCOM
  • SPECT

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Influence of subtraction ictal SPECT on surgical management in focal epilepsy of indeterminate localization : A prospective study. / Tan, K. Meng; Britton, Jeffrey W.; Buchhalter, Jeffrey R.; Worrell, Gregory Alan; Lagerlund, Terrence D.; Shin, Cheolsu; Cascino, Gregory D; Meyer, Fredric B.; So, Elson L.

In: Epilepsy Research, Vol. 82, No. 2-3, 12.2008, p. 190-193.

Research output: Contribution to journalArticle

Tan, K. Meng ; Britton, Jeffrey W. ; Buchhalter, Jeffrey R. ; Worrell, Gregory Alan ; Lagerlund, Terrence D. ; Shin, Cheolsu ; Cascino, Gregory D ; Meyer, Fredric B. ; So, Elson L. / Influence of subtraction ictal SPECT on surgical management in focal epilepsy of indeterminate localization : A prospective study. In: Epilepsy Research. 2008 ; Vol. 82, No. 2-3. pp. 190-193.
@article{ad36c1b47d154a68be67daddbebc0512,
title = "Influence of subtraction ictal SPECT on surgical management in focal epilepsy of indeterminate localization: A prospective study",
abstract = "The impact of functional imaging tests on the decision-making and planning process for epilepsy surgery has never been prospectively assessed. We prospectively evaluated 50 consecutively eligible patients whose noninvasive evaluations showed nonlocalized findings and determined how their SISCOM (subtraction ictal SPECT [single photon emission computed tomography] co-registered to MRI [magnetic resonance imaging]) data altered consensus decisions for epilepsy surgery. At an epilepsy surgery conference where each patient was discussed, consensus decisions were documented after a standardized presentation of data from the noninvasive evaluation (SISCOM findings initially were excluded). Consensus decisions were again documented after presentation of SISCOM data. Consensus decisions changed for 10 of 32 patients (31{\%}) with localizing SISCOM results, whereas the decision changed in only 1 of 18 patients (6{\%}) with nonlocalizing SISCOM results (P < .05). Changes in consensus decisions were as follows: (1) intracranial electrode implantation (IEI) was obviated and resective surgery was recommended (n = 2); (2) resective surgery or further evaluation for patients initially not considered surgical candidates (n = 2); (3) IEI in patients for whom it was not recommended initially (n = 3); (4) increased IEI coverage (n = 3); and (5) antiepileptic drug trial or vagal nerve stimulation was recommended instead of IEI (n = 1). For some patients whose noninvasive evaluations did not clearly localize a surgical focus, SISCOM data can have a major impact on decisions to recommend resective epilepsy surgery or IEI.",
keywords = "Epilepsy surgery, Seizures, SISCOM, SPECT",
author = "Tan, {K. Meng} and Britton, {Jeffrey W.} and Buchhalter, {Jeffrey R.} and Worrell, {Gregory Alan} and Lagerlund, {Terrence D.} and Cheolsu Shin and Cascino, {Gregory D} and Meyer, {Fredric B.} and So, {Elson L.}",
year = "2008",
month = "12",
doi = "10.1016/j.eplepsyres.2008.08.007",
language = "English (US)",
volume = "82",
pages = "190--193",
journal = "Epilepsy Research",
issn = "0920-1211",
publisher = "Elsevier",
number = "2-3",

}

TY - JOUR

T1 - Influence of subtraction ictal SPECT on surgical management in focal epilepsy of indeterminate localization

T2 - A prospective study

AU - Tan, K. Meng

AU - Britton, Jeffrey W.

AU - Buchhalter, Jeffrey R.

AU - Worrell, Gregory Alan

AU - Lagerlund, Terrence D.

AU - Shin, Cheolsu

AU - Cascino, Gregory D

AU - Meyer, Fredric B.

AU - So, Elson L.

PY - 2008/12

Y1 - 2008/12

N2 - The impact of functional imaging tests on the decision-making and planning process for epilepsy surgery has never been prospectively assessed. We prospectively evaluated 50 consecutively eligible patients whose noninvasive evaluations showed nonlocalized findings and determined how their SISCOM (subtraction ictal SPECT [single photon emission computed tomography] co-registered to MRI [magnetic resonance imaging]) data altered consensus decisions for epilepsy surgery. At an epilepsy surgery conference where each patient was discussed, consensus decisions were documented after a standardized presentation of data from the noninvasive evaluation (SISCOM findings initially were excluded). Consensus decisions were again documented after presentation of SISCOM data. Consensus decisions changed for 10 of 32 patients (31%) with localizing SISCOM results, whereas the decision changed in only 1 of 18 patients (6%) with nonlocalizing SISCOM results (P < .05). Changes in consensus decisions were as follows: (1) intracranial electrode implantation (IEI) was obviated and resective surgery was recommended (n = 2); (2) resective surgery or further evaluation for patients initially not considered surgical candidates (n = 2); (3) IEI in patients for whom it was not recommended initially (n = 3); (4) increased IEI coverage (n = 3); and (5) antiepileptic drug trial or vagal nerve stimulation was recommended instead of IEI (n = 1). For some patients whose noninvasive evaluations did not clearly localize a surgical focus, SISCOM data can have a major impact on decisions to recommend resective epilepsy surgery or IEI.

AB - The impact of functional imaging tests on the decision-making and planning process for epilepsy surgery has never been prospectively assessed. We prospectively evaluated 50 consecutively eligible patients whose noninvasive evaluations showed nonlocalized findings and determined how their SISCOM (subtraction ictal SPECT [single photon emission computed tomography] co-registered to MRI [magnetic resonance imaging]) data altered consensus decisions for epilepsy surgery. At an epilepsy surgery conference where each patient was discussed, consensus decisions were documented after a standardized presentation of data from the noninvasive evaluation (SISCOM findings initially were excluded). Consensus decisions were again documented after presentation of SISCOM data. Consensus decisions changed for 10 of 32 patients (31%) with localizing SISCOM results, whereas the decision changed in only 1 of 18 patients (6%) with nonlocalizing SISCOM results (P < .05). Changes in consensus decisions were as follows: (1) intracranial electrode implantation (IEI) was obviated and resective surgery was recommended (n = 2); (2) resective surgery or further evaluation for patients initially not considered surgical candidates (n = 2); (3) IEI in patients for whom it was not recommended initially (n = 3); (4) increased IEI coverage (n = 3); and (5) antiepileptic drug trial or vagal nerve stimulation was recommended instead of IEI (n = 1). For some patients whose noninvasive evaluations did not clearly localize a surgical focus, SISCOM data can have a major impact on decisions to recommend resective epilepsy surgery or IEI.

KW - Epilepsy surgery

KW - Seizures

KW - SISCOM

KW - SPECT

UR - http://www.scopus.com/inward/record.url?scp=56449112638&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=56449112638&partnerID=8YFLogxK

U2 - 10.1016/j.eplepsyres.2008.08.007

DO - 10.1016/j.eplepsyres.2008.08.007

M3 - Article

C2 - 18835758

AN - SCOPUS:56449112638

VL - 82

SP - 190

EP - 193

JO - Epilepsy Research

JF - Epilepsy Research

SN - 0920-1211

IS - 2-3

ER -