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Imaging epilepsy with SISCOM

Nature Reviews Neurology volume 7, page 240 (2011)Cite this article

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We read with interest the Review by Duncan (Imaging in the surgical treatment of epilepsy. Nat. Rev. Neurol. 6, 537–550; 2010) on the role of imaging in epilepsy surgery.1 The combination of functional MRI with EEG or magnetoencephalography is a useful method for studying the irritative zone during the interictal period. These technologies are, however, of limited use for studying ictal activity, a fundamental step in the presurgical evaluation of refractory epilepsy. Although mentioned by Duncan in his article, we feel a slightly expanded discussion is warranted concerning the use of computer-aided subtraction ictal single-photon emission CT coregistered to MRI (SISCOM) and its variants to identify an epileptogenic zone.2,3 In our view, this methodology has been poorly explored in the context of refractory epilepsy, and provides valuable information for the identification of ictal activity and seizure propagation that has not been matched by other methods to date.

Presurgical SISCOM can provide valuable prognostic information. In some studies, resection of the entire epileptogenic zone, as identified by SISCOM, has been associated with good surgical outcome.4,5,6,7 SISCOM might also be used to contraindicate surgical resections.3 Finally, SISCOM might permit the study of the epileptogenic zone, seizure propagation and the relationship between seizures and the underlying morphological neural substrates, allowing insights into the mechanisms of seizure propagation.9,10

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Figure 1: SISCOM can reveal the epileptogenic zone.

References

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Acknowledgements

The authors are supported by Brazilian governmental research grants CNPq and FAPESP.

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  1. Division of Neurology, Basic Research and Advanced Investigations in Neurology Laboratory, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2350, Porto Alegre, 90035-903, RS, Brazil

    Marino M. Bianchin

  2. Center for Epilepsy Surgery, Hospital das Clínicas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 14048-900, SP, Brazil

    Lauro Wichert-Ana, Tonicarlo R. Velasco, Ana Paula P. Martins & Américo C. Sakamoto

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  1. Marino M. Bianchin
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Correspondence to Marino M. Bianchin.

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Bianchin, M., Wichert-Ana, L., Velasco, T. et al. Imaging epilepsy with SISCOM. Nat Rev Neurol 7, 240 (2011). https://doi.org/10.1038/nrneurol.2010.131-c1

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