{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T12:10:03Z","timestamp":1755864603830,"version":"3.44.0"},"reference-count":23,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T00:00:00Z","timestamp":1717718400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia Open"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The main goal of presurgical evaluation in drug\u2010resistant focal epilepsy is to identify a seizure onset zone (SOZ). Of the noninvasive, yet resource\u2010intensive tests available, ictal single\u2010photon emission computed tomography (SPECT) aids SOZ localization by measuring focal increases in blood flow within the SOZ via intravenous peri\u2010ictal radionuclide administration. Recent studies indicate that geographic and center\u2010specific factors impact utilization of these diagnostic procedures. Our study analyzed successful ictal SPECT acquisition (defined as peri\u2010ictal injection during inpatient admission) using surgery\u2010related data from the Pediatric Epilepsy Research Consortium (PERC) surgery database. We hypothesized that a high seizure burden, longer duration of video EEG monitoring (VEEG), and more center\u2010specific hours of SPECT availability would increase the likelihood of successful ictal SPECT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We identified study participants (\u226418\u2009years of age) who underwent SPECT as part of their phase 1 VEEG from January 2018 to June 2022. We assessed association between ictal SPECT outcomes (success vs. failure) and variables including patient demographics, epilepsy history, and center\u2010specific SPECT practices.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Phase 1 VEEG monitoring with ictal SPECT injection was planned in 297 participants and successful in 255 participants (85.86%). On multivariable analysis, the likelihood of a successful SPECT injection was higher in patients of non\u2010Hispanic ethnicity (<jats:italic>p<\/jats:italic>\u2009=\u20090.040), shorter duration VEEG (<jats:italic>p<\/jats:italic>\u2009=\u20090.004), and higher hours of available SPECT services (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Higher seizure frequency (<jats:italic>p<\/jats:italic>\u2009=\u20090.033) was significant only in bivariate analysis. Patients treated at centers with more operational hours were more likely to experience pre\u2010admission protocols prior to VEEG (<jats:italic>p<\/jats:italic>\u2009=\u20090.002).<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>There is inter\u2010center variability in protocols and SPECT acquisition capabilities. Shorter duration of EEG monitoring, non\u2010Hispanic ethnicity (when on private insurance), extended operational hours of nuclear medicine as noted on multivariate analysis and higher seizure frequency in bivariate analysis are strongly associated with successful ictal SPECT injection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Plain Language Summary<\/jats:title><jats:p>In pediatric patients with drug\u2010resistant epilepsy, single\u2010photon emission computed tomography (SPECT) scans can be helpful in localizing seizure onset zone. However, due to many logistical challenges described below, which include not only the half\u2010life of the technetium isotope used to inject intravenously during a seizure (called the ictal SPECT scan) but also available nuclear scanner time in addition to the unpredictability of seizures, obtaining an ictal SPECT during a planned elective inpatient hospital stay is not guaranteed. Thus, as healthcare costs increase, planning a prolonged hospital stay during which an ictal SPECT scan is not feasible is not optimal. We leveraged our prospective surgery database to look at center\u2010specific factors and patient\u2010specific factors associated with an ictal SPECT injection in the first, pediatric\u2010focussed, large\u2010scale, multicenter, prospective, SPECT feasibility study. We found that longer availability of the scanner is the most important center\u2010specific factor in assuring ictal SPECT injection. Although seizure frequency is an important patient\u2010specific factor on bivariate analysis, this factor lost statistical significance when other factors like patient insurance status and video EEG duration were also considered in our multivariable logistical model.<\/jats:p><\/jats:sec>","DOI":"10.1002\/epi4.12986","type":"journal-article","created":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T03:40:59Z","timestamp":1717731659000},"page":"1467-1479","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Determinants of successful ictal <scp>SPECT<\/scp> injection in phase 1 epilepsy presurgical evaluation: Findings from the pediatric epilepsy research consortium surgery database project"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4502-7242","authenticated-orcid":false,"given":"Charuta","family":"Joshi","sequence":"first","affiliation":[{"name":"University of Texas Southwestern, Children's Health  Dallas Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rani","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Pediatrics Atrium Health\/Levine Children's Hospital  Charlotte North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Atrium Health\/Levine Children's Hospital, Charlotte, NC, Department of Biostatistics and Data Science Wake Forest University School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9516-2285","authenticated-orcid":false,"given":"Cemal","family":"Karakas","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology, Department of Neurology University of Louisville, Norton Children's Hospital  Louisville Kentucky USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Ciliberto","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Iowa Hospitals and Clinics  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4249-338X","authenticated-orcid":false,"given":"Krista","family":"Eschbach","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Neurology University of Colorado, Children's Hospital Colorado  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1825-846X","authenticated-orcid":false,"given":"M. Scott","family":"Perry","sequence":"additional","affiliation":[{"name":"Jane and John Justin Institute for Mind Health, Cook Children's Medical Center  Fort Worth Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Shrey","sequence":"additional","affiliation":[{"name":"Division of Neurology Children's Hospital Orange County  Orange California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tricia","family":"Morphew","sequence":"additional","affiliation":[{"name":"Children's Hospital Orange County Research Institute  Orange California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9994-6650","authenticated-orcid":false,"given":"Adam P.","family":"Ostendorf","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Nationwide Children's Ohio State University  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shilpa B.","family":"Reddy","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology, Monroe Carell Jr Children's Hospital Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"McCormack","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology, Monroe Carell Jr Children's Hospital Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2829-2458","authenticated-orcid":false,"given":"Samir","family":"Karia","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology, Department of Neurology University of Louisville, Norton Children's Hospital  Louisville Kentucky USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shrishti","family":"Nangia","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology Weill\u2010Cornell Medicine  New York City New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lily","family":"Wong\u2010Kisiel","sequence":"additional","affiliation":[{"name":"Department of Neurology, Divisions of Child Neurology and Epilepsy Mayo Clinic College of Medicine  Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the PERC Surgery Workgroup","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,6,7]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-444-52891-9.00043-9"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2019.05.008"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0000000000001880_149"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000207811"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.709400"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/epi4.12373"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/MNM.0000000000001755"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta16340"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/1535759719894307"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17124"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17670"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2015.07.007"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000013130"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17452"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0013-9580.2004.04008.x"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-444-52898-8.00027-6"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.113.136432"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/epi4.12795"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2021.106691"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182897082"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-017-8560-6"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1528-1157.2003.24203.x"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2023.109571"}],"container-title":["Epilepsia Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epi4.12986","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T11:47:26Z","timestamp":1755863246000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/epi4.12986"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,7]]},"references-count":23,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1002\/epi4.12986"],"URL":"https:\/\/doi.org\/10.1002\/epi4.12986","archive":["Portico"],"relation":{},"ISSN":["2470-9239","2470-9239"],"issn-type":[{"type":"print","value":"2470-9239"},{"type":"electronic","value":"2470-9239"}],"subject":[],"published":{"date-parts":[[2024,6,7]]},"assertion":[{"value":"2024-02-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}