Does SISCOM contribute to favorable @entity410 outcome after XXXX surgery?

@entity1 @entity410 @entity302
PURPOSE: To assess the additional value of subtraction ictal single-photon emission computed tomography (SPECT) coregistered to MRI (SISCOM) for localization of the epileptogenic zone in @entity1 with drug-resistant @entity302 scheduled for invasive video-EEG (VEEG) before @entity302 surgery by a descriptive study from clinical practice. METHODS: Forty-nine consecutive @entity302 @entity1 between January 2000 and March 2006 were included. Thirty-six of the 49 @entity1 were offered surgery, and 34 underwent resective surgery during the study period. Localizing and outcome data are presented from 31 @entity1 with a follow-up period of >or=12 months. Successful ictal SPECT was performed in 26 @entity1 , and SISCOM showed significant hyperperfusions with 3.5 SD above reference. Twenty @entity1 had SISCOM-guided electrode placement, invasive monitoring, and 1-year postsurgical follow-up data. Two independent epileptologists evaluated whether SISCOM results (a) altered the hypothesis and extended the strategy for electrode placement at invasive recording, or (b) were confirmatory of other localizing data and did not alter the strategy. We defined that SISCOM had an impact on @entity410 outcome if the @entity410 -onset zone was seen in electrodes overlying a brain region with a significant hyperperfusion. When SISCOM was concordant with ictal onset in the extended electrodes, SISCOM was considered a prerequisite for the outcome at postoperative follow-up. RESULTS: SISCOM findings altered and extended the strategy for electrode placement at invasive recording in 15 @entity1 (group A). SISCOM was a prerequisite for @entity410 outcome in all six @entity1 with favorable outcomes. Nine @entity1 had poor results from surgery in this group; SISCOM was concordant with invasive VEEG in six @entity1 , and discordant with invasive VEEG in three @entity1 . SISCOM findings were confirmatory with other localizing data and did not alter the strategy at invasive recording in five @entity1 (group B). Two @entity1 had favorable surgical outcomes. In this group, three @entity1 had poor results; SISCOM and other localizing findings were concordant with invasive VEEG in one @entity1 and discordant with invasive VEEG in two @entity1 . CONCLUSIONS: SISCOM is valuable for the identification of the epileptogenic zone in @entity1 with drug-resistant @entity302 scheduled for invasive VEEG. SISCOM analysis was either a prerequisite for favorable result or concordant with other localizing methods in all @entity1 with favorable @entity410 outcome at 1 year of follow-up [40%; confidence interval (CI), 19-64).
