by Jennifer Madison
, DOTmed News Reporter | January 21, 2010
Epilepsy is a disorder affecting more than three million Americans; Researchers at Mayo Clinic have developed a new technique to increase post-surgical seizure freedom in patients suffering from temporal lobe epilepsy (TLE), by pinpointing seizure location.
The STATistical Ictal SPECT COregistered to MRI (STATISCOM) demonstrates improved surgical accuracy over the previously used Subtraction Ictal SPECT COregistered to MRI (SISCOM) method, according to Dr. Elson So, professor of neurology at Mayo Clinic's Rochester, Minnesota campus.
So led a team of researchers in developing the new method. They predict its advancement will benefit epileptic patients in the long and short term. Fellow lead researcher Dr. Gregory Worrell tells DOTmed News, "This test is geared toward identifying where seizures come from and that is the primary goal for epilepsy surgery. Despite taking multiple medications, about a third of patients continue to suffer from seizures. This approach will give us a better localization of where seizures are in the brain - the first step in whether patients can benefit from epilepsy surgery."
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In a Mayo Clinic study comparing the methods, researchers performed two serial studies using SPECT - a single-photon emission computerized tomography scan taken during a seizure - on 11 healthy volunteers without epilepsy. "The SPECT technique relies on technology's use of a radioisotope, which is injected into the bloodstream. It will flow to the area of the brain where the seizure is and you can use imaging to locate where the radioisotope is in the brain," Worrell explains. Reviewers, blinded to clinical data and outcomes, found they were able to detect brain abnormalities two times better using STATISCOM than with SISCOM. "If your life is a movie, this (STATISCOM) provides a snapshot," he says.
SISCOM's limitations included the method's inability to account for normal variations in blood flow - variations now considered using STATISCOM. "Every individual's brain waves, blood flow and heart rate vary from minute to minute, even second to second. In fact, the accuracy of the 'hot spot' within the temporal lobe is nearly three times better with STATISCOM than with SISCOM," So explains.
So is confident the team's research has closed gaps in previous seizure localization methods for sufferers. "It is imperative that we can clearly and distinctively pinpoint seizure location in the brain. In many cases, the standard tests of MRI and EEG cannot do so," he says.
However, Worrell notes when used together the methods pose added benefits: "MRI is a structural imaging study, a study that tells you the shape and structure of the brain. But it doesn't tell you about activity in the brain. The EEG tells you about ongoing electrical activity, and SPECT tells you about blood flow. They are completely different modalities and give you different information but all complementary information. No one test gives the total story." He adds of future planned research, "The goal with epilepsy surgery is to render the patients seizure free. We're working on brain imaging modalities, computational approaches, SPECT and also EEG, MRI, and brain simulations."
Findings of this study were published in the January issue of Neurology.