Abstract Details

Title Population Statistics-Based SPECT Analysis in Nonlesional Extratemporal Lobe Epilepsy

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S28 - (-)

Poster/Presentation
Number 004

Objective

Background SISCOM is clinically useful in epilepsy surgery evaluation, although it does not determine whether the ictal-interictal difference is statistically different from the expected random variation between two SPECT studies. To overcome this issue, methods using statistical maps derived from scans of control subjects were developed.

Design/Methods We retrospectively identified 30 cases of nonlesional medically refractory extratemporal epilepsy that had a normal preoperative seizure protocol MRI and underwent epilepsy surgery between January 1998 and December 2005 at Mayo Clinic, Rochester, MN. For statistical part two serial SPECT studies were performed in 30 healthy volunteers without epilepsy (control subjects) to measure random variation between paired studies. Custom software was created capable of displaying, reviewing, and annotating MRI and thresholded hyperperfusion and hypoperfusion images in sagittal, axial and coronal planes. In this study two reviewers blinded to clinical data and type of analysis marked the most probable lobe of seizure.

Results Interobserver agreement between blinded reviewers was higher for population statistics-based methods (STATISCOM and ISAS - kappa score 0.66, and 0.44) than for SISCOM (kappa 0.36). STATISCOM identified a hyperperfusion focus in 90%, ISAS in 92% and SISCOM in 62%. STATISCOM correctly localized side of resection in 73%, ISAS in 72% and SICOM in 52% (STATISCOM vs SISCOM; p=0.004; ISAS vs SISCOM; p=0.01). There was no significant difference between the two population statistic-based methods (p=1).

Conclusions Quantitative SPECT image processing using population statistics-based methods is superior in seizure localization to methods relying on interictal-ictal subtraction.

Authors/Disclosures
Vlastimil Sulc PRESENTER	No disclosure on file
Stefano Jann, MD	No disclosure on file
	No disclosure on file
	No disclosure on file
Benjamin H. Brinkmann, PhD (Mayo Clinic)	Dr. Brinkmann has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eisai. Dr. Brinkmann has stock in Cadence Neuroscience. The institution of Dr. Brinkmann has received research support from Epilepsy Foundation of America. The institution of Dr. Brinkmann has received research support from National Institutes of Health. The institution of Dr. Brinkmann has received research support from National Institutes of Health. The institution of Dr. Brinkmann has received research support from UNEEG A/S. The institution of Dr. Brinkmann has received research support from Seer Medical Pty. The institution of Dr. Brinkmann has received research support from Neurelis Inc. Dr. Brinkmann has received intellectual property interests from a discovery or technology relating to health care.
David T. Jones, MD (Mayo Clinic)	Dr. Jones has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
	No disclosure on file
Matthew Senjem (Mayo Clinic)	Matthew Senjem has received stock or an ownership interest from Align Technology, Inc.. Matthew Senjem has received stock or an ownership interest from Inovio Biomedical Corp.. Matthew Senjem has received stock or an ownership interest from Johnson & Johnson. Matthew Senjem has received stock or an ownership interest from Mesa Laboratories, Inc.. Matthew Senjem has received stock or an ownership interest from Nvidia Inc.. Matthew Senjem has received stock or an ownership interest from LHC Group, Inc.. Matthew Senjem has received stock or an ownership interest from Natus Medical Incorporated. Matthew Senjem has received stock or an ownership interest from Varex Imaging Corporation. Matthew Senjem has received personal compensation in the range of $100,000-$499,999 for serving as a IT Technical Specialist II with Mayo Clinic.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Gregory D. Cascino, MD, FAAN (Mayo Clinic)	Dr. Cascino has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for International League Against Epilepsy . Dr. Cascino has received intellectual property interests from a discovery or technology relating to health care. Dr. Cascino has received publishing royalties from a publication relating to health care. Dr. Cascino has received publishing royalties from a publication relating to health care.
Lily Wong-Kisiel, MD, FAAN (Mayo Clinic)	Dr. Wong-Kisiel has nothing to disclose.
Jeffrey W. Britton, MD, FAAN (Mayo Graduate School of Medicine)	Dr. Britton has received personal compensation in the range of $0-$499 for serving as a Online course with American Clinical Neurophysiology Society.
Elson L. So, MD, FAAN (Mayo Clinic)	Dr. So has nothing to disclose.
Gregory A. Worrell, MD (Mayo Clinic College of Medicine)	Dr. Worrell has received stock or an ownership interest from NeuroOne Inc.. Dr. Worrell has received stock or an ownership interest from Cadence Neuroscience Inc. The institution of Dr. Worrell has received research support from NIH. The institution of Dr. Worrell has received research support from Medtronic Inc.. The institution of Dr. Worrell has received research support from Neuropace Inc,. The institution of Dr. Worrell has received research support from Epilepsy Foundation of America. Dr. Worrell has received intellectual property interests from a discovery or technology relating to health care. Dr. Worrell has received intellectual property interests from a discovery or technology relating to health care.

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