Up to 30% of patients with epilepsy may not respond to antiepileptic drugs. Patients with drug-resistant epilepsy (DRE) should undergo evaluation for seizure onset zone (SOZ) localization to consider surgical treatment. Cases of drug-resistant nonlesional extratemporal lobe epilepsy (ETLE) pose the biggest challenge in localizing the SOZ and require multiple noninvasive diagnostic investigations before planning the intracranial monitoring (ICM) or direct resection. Ictal Single Photon Emission Computed Tomography (i-SPECT) is a unique functional diagnostic tool that assesses the SOZ using the localized hyperperfusion that occurs early in the seizure. Subtraction ictal SPECT coregistered to MRI (SISCOM), statistical ictal SPECT coregistered to MRI (STATISCOM), and PET interictal subtracted ictal SPECT coregistered with MRI (PISCOM) are innovative SPECT methods for the determination of the SOZ. This article comprehensively reviews SPECT and sheds light on its vital role in the presurgical evaluation of the nonlesional extratemporal DRE.

中文翻译：

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创新 SPECT 技术在非病灶颞外耐药性癫痫患者术前评估中的应用

高达 30% 的癫痫患者可能对抗癫痫药物没有反应。耐药性癫痫 (DRE) 患者应接受癫痫发作起始区 (SOZ) 定位评估，以考虑手术治疗。耐药性非病灶性颞叶外癫痫 (ETLE) 病例是定位 SOZ 的最大挑战，需要在计划颅内监测 (ICM) 或直接切除之前进行多次无创诊断调查。发作期单光子发射计算机断层扫描 (i-SPECT) 是一种独特的功能性诊断工具，可使用癫痫发作早期发生的局部高灌注来评估 SOZ。减法发作期 SPECT 与 MRI 联合注册 (SISCOM)，统计发作期 SPECT 与 MRI 联合注册 (STATISCOM)，和 PET 发作间期减去发作期 SPECT 与 MRI 联合注册 (PISCOM) 是用于确定 SOZ 的创新 SPECT 方法。本文全面回顾 SPECT 并阐明其在非损伤性颞外 DRE 术前评估中的重要作用。