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New Method for Triggering and Imaging Seizures to Help Guide Epilepsy Surgery

By MedImaging International staff writers
Posted on 13 Mar 2024

Image: Overview of the seizure triggering electrodes and the brain reconstruction method (Photo courtesy of University Hospital of Bern)

Individuals experiencing epilepsy and seizures unmanageable with medication often find brain surgery beneficial. This procedure aims to excise the epileptic tissue while preserving healthy tissue, thus controlling seizures without inducing neurological damage. Accurately identifying the epileptic tissue is crucial for the success of such surgeries, and the acquisition of images during seizures can significantly enhance the precision of surgical planning. Traditionally, ictal SPECT has been the exclusive neuro-imaging technique capable of capturing seizures as they occur within the brain since the 1990s. Yet, the increasing demands on healthcare resources and time have led many epilepsy centers to forgo this informative method. A new approach for inducing and imaging seizures could now enable clinicians to obtain real-time insights for customizing epilepsy surgery more effectively.

In comparison to the previous approach, where physicians from neurology and nuclear medicine waited for hours to days to capture the onset of a seizure, the new method developed by researchers at University Hospital of Bern (Bern, Switzerland), is more convenient, requires fewer resources, and is clinically feasible. In their study involving three adult subjects with left temporal lobe epilepsy, the researchers decided not to wait for spontaneous occurrences and instead imaged planned seizures that were triggered with targeted electrical stimulation to the brain. The research team employed stereotactic electroencephalography (sEEG) leads placed in specific brain regions to induce seizures characteristic of each patient. A radiotracer, 99mTc-HMPAO, was administered within 12 seconds of the seizure's start, with SPECT imaging following within 40 minutes.

The method successfully triggered seizures in all the participants, replicating each patient's typical seizure presentation and electrographic pattern observed through sEEG, without causing any adverse effects. The seizures induced were specific for each patient, with early seizure spread being uniquely imaged. In the first two cases, ictal SPECT provided additional insights beyond those offered by sEEG, highlighting the early involvement of brain regions lacking electrode coverage. In the third case, both sEEG and ictal SPECT provided overlapping information.

“The finding of this study is of practical nature, as it greatly facilitates the acquisition of the ictal SPECT,” said Thomas Pyka, MD, Privatdozent in the Department of Nuclear Medicine at the University Hospital of Bern. “This may help obtain images of greater quality and could contribute to the refinement of resection planning, improving seizure and cognitive outcomes in epilepsy surgery.”

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90 (854.0153503418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

91 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

92 (512.83836364746): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294800545 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

93 (!!!!! 2119.779586792): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

94 (163.07830810547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

95 (!!!!! 4598.1407165527): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294800545 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

96 (!!!!! 7811.0694885254): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

97 (!!!!! 7974.8630523682): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

98 (!!!!! 9767.0555114746): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

99 (!!!!! 6263.9713287354): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

100 (!!!!! 7669.9256896973): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

101 (!!!!! 7876.1577606201): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

102 (!!!!! 9346.9619750977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

103 (!!!!! 7511.1389160156): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

104 (452.99530029297): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

105 (!!!!! 155545.94993591): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

106 (138.0443572998): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

107 (132.08389282227): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

108 (368.83354187012): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800545 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800545 AND type='deeppockets_item' AND published='1' LIMIT 1

109 (!!!!! 1683858.87146): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

110 (!!!!! 1140573.0247498): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

111 (423.90823364258): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

112 (358.81996154785): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

113 (456.09474182129): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

114 (403.88107299805): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

115 (638.96179199219): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

116 (46.014785766602): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

117 (409.12628173828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

118 (190.97328186035): SELECT name FROM jos_deeppockets WHERE id=213

119 (254.86946105957): SELECT name FROM jos_deeppockets WHERE id=213

120 (603.91426086426): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

121 (!!!!! 1888.9904022217): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

122 (!!!!! 2562.9997253418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

123 (571.01249694824): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

124 (!!!!! 15599.012374878): TRUNCATE TABLE jos_trademed_module

125 (136.8522644043): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294800545 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

126 (617.98095703125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

127 (166.17774963379): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

128 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

129 (102.99682617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

130 (!!!!! 3528.1181335449): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

131 (!!!!! 4649.8775482178): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

132 (!!!!! 1332.0446014404): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

133 (!!!!! 1927.1373748779): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800545 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800545 AND type='deeppockets_item' AND published='1' LIMIT 1

134 (!!!!! 5516.0522460938): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

135 (237.94174194336): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

136 (435.11390686035): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

137 (242.94853210449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

138 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800545 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800545 AND published='1' LIMIT 1

139 (545.97854614258): select jos_twitters.link from jos_twitters where cat=10

140 (128.98445129395): select jos_facebook.link from jos_facebook where cat=10

141 (102.04315185547): select jos_google_plus.link from jos_google_plus where cat=10

142 (72.956085205078): select jos_linkedin.link from jos_linkedin where cat=10

143 (393.86749267578): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

144 (!!!!! 1416.9216156006): insert into jos_banners_delta values (14615,'2025-04-29 10:31:51','3.143.7.75','view'),(14202,'2025-04-29 10:31:51','3.143.7.75','view'),(14203,'2025-04-29 10:31:51','3.143.7.75','view')

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