Localization of the epileptogenic tuber with electric source imaging in patients with tuberous sclerosis

Odysseas Kargiotis; Agustina M Lascano; Valentina Garibotto; Laurent Spinelli; Melanie Genetti; Michael Wissmeyer; Christian M Korff; Shahan Momjian; Christoph M Michel; Margitta Seeck; Serge Vulliemoz

doi:10.1016/j.eplepsyres.2013.11.003

Localization of the epileptogenic tuber with electric source imaging in patients with tuberous sclerosis

Epilepsy Res. 2014 Feb;108(2):267-79. doi: 10.1016/j.eplepsyres.2013.11.003. Epub 2013 Nov 19.

Affiliations

¹ Functional Brain Mapping Lab, Faculty of Medicine, University of Geneva, Switzerland.
² Functional Brain Mapping Lab, Faculty of Medicine, University of Geneva, Switzerland; EEG and Epilepsy Unit, Neurology Clinic, University Hospital and Faculty of Medicine of Geneva, Switzerland.
³ Nuclear Medicine, Department of Radiology, University Hospital and Faculty of Medicine of Geneva, Switzerland.
⁴ Pediatric Neurology, Child and Adolescent Department, University Hospital and Faculty of Medicine of Geneva, Switzerland.
⁵ Department of Neurosurgery, University Hospital and Faculty of Medicine of Geneva, Switzerland.
⁶ EEG and Epilepsy Unit, Neurology Clinic, University Hospital and Faculty of Medicine of Geneva, Switzerland.
⁷ Functional Brain Mapping Lab, Faculty of Medicine, University of Geneva, Switzerland; EEG and Epilepsy Unit, Neurology Clinic, University Hospital and Faculty of Medicine of Geneva, Switzerland. Electronic address: Serge.Vulliemoz@hcuge.ch.

PMID: 24315017
DOI: 10.1016/j.eplepsyres.2013.11.003

Abstract

Purpose: Patients with tuberous sclerosis complex (TSC) often suffer from medically refractory epilepsy. Despite the multifocality of the disease, resection of the most epileptogenic tuber can lead to major improvement of seizure control. Therefore, non-invasive imaging methods are needed for detecting epileptogenic sources. We assessed the utility of electric source imaging (ESI) in the presurgical work-up of TSC patients and its combination with Positron Emission Tomography (PET) and ictal/interictal Single Photon Emission Computed Tomography (SISCOM).

Methods: Thirteen patients underwent high density ESI (8/13) and/or low density ESI (13/13). We investigated the concordance between ESI, PET, SISCOM and the resection area in the 11 operated patients (nine seizure-free).

Results: High resolution ESI was partially or completely concordant with the resected area in 5/5 seizure free patients. Low resolution ESI was partially or completely concordant in 7/9 seizure free patients. PET and SPECT were concordant (partially or completely) in 8/9 and 6/9 cases, respectively. We found multifocal ESI sources in 2/9 seizure free patients, marked multifocal PET hypometabolism in 3/9 and multifocal SISCOM in 4/9. The region of concordant ESI and PET accurately predicted the dominant epileptogenic source in 6/9 patients. The same was true for concordant ESI and SISCOM in 4/9 patients, whereas the coregistration of only PET and SISCOM was insufficient in 3/9 successfully operated cases. The combination of all three imaging modalities could successfully identify the resection area in all but one patient with a favorable post-operation outcome.

Conclusion: ESI is an important tool for the pre-surgical evaluation of TSC patients. It complements PET and SPECT results and can improve the management of candidates for surgery when integrated with electro-clinical information.

Keywords: Electric source imaging; Epilepsy surgery; Multifocal epilepsy; Pre-surgical evaluation; Tuberous sclerosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Child
Child, Preschool
Electroencephalography / methods*
Epilepsy / diagnosis*
Epilepsy / physiopathology*
Female
Humans
Infant
Male
Retrospective Studies
Tomography, Emission-Computed, Single-Photon / methods
Tuberous Sclerosis / diagnosis*
Tuberous Sclerosis / physiopathology*
Young Adult