AUTHOR=Oliveira Young Carla , Etchbehere Elba C. S. C. , Souza Edna Marina , Brunetto Sergio Querino , Santos Allan de Oliveira , Lima Mariana C. L. , Ortiz-De la Rosa Sebastian , Alvim Marina , Yasuda Clarissa Lin , Ramos Celso Darío , Cendes Fernando , Amorim Barbara Juarez 

TITLE=Clinical Usefulness of SISCOM-SPM Compared to Visual Analysis to Locate the Epileptogenic Zone

JOURNAL=Frontiers in Neurology

VOLUME=11

YEAR=2020

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.00467

DOI=10.3389/fneur.2020.00467

ISSN=1664-2295

ABSTRACT=<p><bold>Introduction:</bold> Subtraction of ictal-interictal SPECT co-registered to MRI (SISCOM) is a quantification tool that can improve the sensitivity and specificity of the epileptogenic zone (EZ) localization. Commercially available image analysis software packages for SISCOM are costly, and Statistical Parametric Mapping (SPM) could be an alternative free software for the definition of the EZ. There are only a few studies that compare SISCOM using SPM (SISCOM-SPM) with visual analysis.</p><p><bold>Aim:</bold> To compare SISCOM-SPM vs. visual analysis for localization of the EZ in patients with pharmacoresistant focal epilepsies.</p><p><bold>Materials and methods:</bold> We evaluated all our patients with focal epilepsies that underwent ictal and interictal SPECT. We defined the reference standard to locate the EZ by pathology and follow-up (in patients submitted to surgery), or seizure semiology, serial EEG, long-term video-EEG, <sup>18</sup>F-FDG PET/CT, and MRI (in patients who were not operated). We compared the location of the EZ by visual analysis of SPECT images and by SISCOM-SPM to the reference standard and classified as <italic>concordant, discordant</italic>, or <italic>partially concordant</italic>.</p><p><bold>Results:</bold> We included 23 patients. Visual analysis was <italic>concordant</italic> with the EZ reference standard in only 13 patients (56.5%), while SISCOM-SPM was <italic>concordant</italic> in 18 cases (78.3%), providing a 21.8% increase in the location of EZ. However, this difference was not significant due to the small sample size (<italic>p</italic> = 0.0856).</p><p><bold>Conclusion:</bold> Our preliminary results demonstrate that, in clinical practice, SISCOM-SPM has the potential to add information that might help localize the EZ compared to visual analysis. SISCOM-SPM has a lower cost than other commercially available SISCOM software packages, which is an advantage for developing countries. Studies with more patients are necessary to confirm our findings.</p>