title: Localization of the epileptogenic tuber with electric source imaging in patients with tuberous sclerosis.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Functional Brain Mapping Lab, Faculty of Medicine, University of Geneva, Switzerland.
authors: Odysseas
authors: O
authors: Kargiotis
authors: 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.
authors: Agustina M
authors: AM
authors: Lascano
authors: Nuclear Medicine, Department of Radiology, University Hospital and Faculty of Medicine of Geneva, Switzerland.
authors: Valentina
authors: V
authors: Garibotto
authors: 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.
authors: Laurent
authors: L
authors: Spinelli
authors: Functional Brain Mapping Lab, Faculty of Medicine, University of Geneva, Switzerland.
authors: Melanie
authors: M
authors: Genetti
authors: Nuclear Medicine, Department of Radiology, University Hospital and Faculty of Medicine of Geneva, Switzerland.
authors: Michael
authors: M
authors: Wissmeyer
authors: Pediatric Neurology, Child and Adolescent Department, University Hospital and Faculty of Medicine of Geneva, Switzerland.
authors: Christian M
authors: CM
authors: Korff
authors: Department of Neurosurgery, University Hospital and Faculty of Medicine of Geneva, Switzerland.
authors: Shahan
authors: S
authors: Momjian
authors: Functional Brain Mapping Lab, Faculty of Medicine, University of Geneva, Switzerland.
authors: Christoph M
authors: CM
authors: Michel
authors: EEG and Epilepsy Unit, Neurology Clinic, University Hospital and Faculty of Medicine of Geneva, Switzerland.
authors: Margitta
authors: M
authors: Seeck
authors: 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.
authors: Serge
authors: S
authors: Vulliemoz
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000379:methods*; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014402:Tuberous Sclerosis / Q000175:diagnosis* / Q000503:physiopathology*; D055815:Young Adult
keywords: Electric source imaging; Epilepsy surgery; Multifocal epilepsy; Pre-surgical evaluation; Tuberous sclerosis