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Prognostic contribution of subtraction between ictal and interictal SPECT and its alignment to MRI (SISCOM) in patients with pharmacoresistant epilepsy associated to normal 3T MRI

Grant number: 12/14152-4
Support Opportunities:Scholarships in Brazil - Doctorate (Direct)
Effective date (Start): May 01, 2013
Effective date (End): June 30, 2017
Field of knowledge:Health Sciences - Medicine - Medical Radiology
Principal Investigator:Lauro Wichert Ana
Grantee:Emerson Nobuyuki Itikawa
Host Institution: Faculdade de Medicina de Ribeirão Preto (FMRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil
Associated research grant:05/56447-7 - Research through images from high field magnetic resonance aimed at studies in humans, AP.CINAPCE.TEM


Epilepsy is a neurological disorder that affect up to 1% from world population, which 30% are pharmacologically intractable epilepsies and for which epilepsy surgery is a therapeutic alternative. Presurgical evaluation aims to localize and resect the Epileptogenic Zone (EZ) and involves a multidisciplinary workup that includes: outpatient EEG, scalp and/or invasive Vídeo-EEG, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Ictal/Interictal SPECTs, PET and neuropsychological evaluations. The MRI is the neuroimage of choice in a search for epileptogenic lesions. The problem arises when high field MRI (3T) is incapable to reveal any structural abnormality (NORMAL MRI). In this case, other diagnostic methods may play a complimentary diagnostic role and may influence the clinical and surgical decisions. Among these methods, SISCOM (Subtraction of Ictal Spect Coregistered with MRI) have been used as a reference to review images of brain MRI and to guide the implantation of invasive electrodes. Objectives: (a) To evaluate the sensitivity, specificity, positive and negative predictive values of SISCOM in EZ localization of patients with NORMAL MRI; (b) To determine the prognostic role of SISCOM relative to the surgical outcome. Patients and methods: Longitudinal and prospective study, which will evaluate the diagnostic accuracy of SISCOM in 40 patients with epilepsy and NORMAL MRI. Patients will undergo to presurgical evaluation with Vídeo-EEG monitoring, and 1.480 MBq (40 mCi) of 99mTc-ECD will be administrated in both ictal (ictal SPECT) and interictal states (interictal SPECT). Brain SPECTs will also be aligned with the volumetric T1-weight sequence (3D-T1) of MRI 3T. All SPECT findings will be correlated to other pre and postsurgical evaluation data. Aimed results: validation of SISCOM in the presurgical evaluation of epileptic patients with NORMAL MRI and the determination of the prognostic role of this technique in patients identified as having good or bad surgical outcomes. (AU)

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Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
PITELLA, FELIPE ARRIVA; TREVISAN, ANA CAROLINA; ALEXANDRE-SANTOS, LEONARDO; KATO, MERY; BRITO, MANUELINA MARIANA CAPELLARI MACRUZ; TUMAS, VITOR; WICHERT-ANA, LAURO. Reference Values for Dopamine Transporter Imaging With Tc-99m-TRODAT-1 in Healthy Subjects and Parkinson's Disease Patients. CLINICAL NUCLEAR MEDICINE, v. 47, n. 9, p. 6-pg., . (15/50089-3, 21/12671-3, 12/14152-4)
Academic Publications
(References retrieved automatically from State of São Paulo Research Institutions)
ITIKAWA, Emerson Nobuyuki. Prognostic contribution of subtraction between ictal and interictal SPECT and its alignment to MRI (SISCOM) in patients with pharmacorresistant epilepsy associated to normal 3T MRI. 2017. Doctoral Thesis - Universidade de São Paulo (USP). Escola de Engenharia de São Carlos (EESC/SBD) São Carlos.

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