Comparison between old and new imaging modalities in the presurgical evaluation of children with intractable epilepsy

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Surgical intervention is often performed to mitigate or stop seizures. Different imaging techniques are used to evaluate those patients presurgically. Herein, we aimed to describe the correlation between seizure semiology, long term video-EEG and neuro-imaging modalities including high resolution three-dimensional structural brain MRI, ASL perfusion, brain volumetric analysis, and FDG-PET scans throughout the presurgical assessment of focal drug-resistant epilepsy patients. Methodology: Here, 30 patients fulfilled the inclusion criteria were included from our pediatric neurology clinic in a period from November 2021 till May 2023. History taking, full examination, 6–24-h long-term Video EEG recording (including ictal and inter-ictal recordings) and multiple neuro-imaging modalities were obtained from all patients. Thirty patients underwent structural MRI brain imaging, 27 patients underwent volumetry studies and 28 patients underwent magnetic resonance arterial spin labeling sequence. PET was done when no proper localization of seizures occurred (n=10). Results: Our multimodal methodology indicated that among patients with focal DRE, temporal lobe epilepsy was the prevailing, impacting 12 patients (40%), followed by frontal lobe epilepsy, impacting 9 patients (30%). There was concordance between Ictal EEG and Inter-ictal EEG regarding the affected side, and the affected lobe . We also found concordance between structural MRI and ASL regarding the affected side and the affected lobe. In addition to between ASL, ictal EEG and PET scan. Conclusion: Focal DRE patients necessitate meticulous multi-disciplinary assessment through detailed seizure semiology analysis, adequate long-term video EEG monitoring, and thorough neuro-imaging including already established techniques such as structural MRI and 18f-FDG PET brain scans and also new emerging techniques such as ASL and automated brain volumetry. Given the benefits of those new techniques regarding image quality, elevated accessibility, and the elimination of intravenous contrast agents, they are optimally suited for pediatric neuro-imaging during the pre-surgical evaluation of focal DRE. Focal Drug-resistant epilepsy Presurgical evaluation Video-EEG MRI brain Arterial spin labeling Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Background Drug-resistant epilepsy (DRE) is marked by the failure of adequate trials with two well selected anti-seizure medications (ASM) with tolerable side effects 1 . Children and adolescents diagnosed with DRE have heightened risk for worse long-term intellectual and psychosocial outcomes. In this kind of resistant epilepsy, suitable surgical intervention is often performed to diminish or stop seizures 2 . The video-EEG monitoring is utilized to perform presurgical evaluation; the simultaneous measurement of the ictal EEG pattern and paroxysmal behavior may validate the seizure disorder diagnosis, evaluate seizure frequency and precipitating factors, categorize seizure types, and aid in surgical localization 3 . In addition to structural magnetic resonance imaging (sMRI), The epileptic zone (EZ) delineation has traditionally been performed using EEG and nuclear imaging modalities. Arterial spin labeling (ASL) sequence is a non-contrast magnetic resonance perfusion technique that can provide comparable information. Its efficacy in epilepsy is contingent upon changing seizure activity-related perfusion through the neurovascular coupling 4 . Here, we aimed to describe the possible correlations between long term video EEG monitoring and multiple neuro-imaging techniques, and to compare old imaging modalities as sMRI brain and FDG-PET scans with new emerging techniques as brain volumetry studies and ASL sequences during the presurgical assessment of focal DRE. 2. Methods This is a prospective observational analytical cohort study. Patients were recruited from November 2021 till May 2023. 2.1 Study Population: Thirty patients below 18 years of age who suffered from intractable focal epilepsy evident by seizure semiology and were on more than 2 antiepileptic drugs. Enrolled cases underwent comprehensive history collection and thorough general and neurological examinations to exclude any generalized systemic illness and identify any associated CNS disorders. 2.2. Presurgical evaluation via A- long-term video EEG monitoring to evaluate and localize ictal onset zones (IOZ). Patients underwent long-term EEG video recording lasting 6 to 24 hours, utilizing different EEG systems per the American Clinical Neurophysiology Society guidelines 5 . B- Magnetic resonance imaging (MRI) at 1.5 Tesla, incorporating an epilepsy protocol, which encompassed T1-weighted sagittal three-dimensional (3D) and 3D fluid-attenuated inversion recovery (FLAIR) sequences with 1 mm-slice thickness isotropic resolution and no intervening gap, coronal T2-weighted images with a 2.5-mm slice thickness and no gap (perpendicular to the hippocampus), diffusion-weighted images, and axial susceptibility-weighted images. The procedure used a 1.5-T MRI machine, specifically a 1.5 Tesla GE SIGNA closed-configuration whole body scanner, with a standard quadrature head coil. Siemens, software version syngo MR E 11, according to the epilepsy imaging protocol established by Cendes and colleagues 6 . C- 3D pseudo-continuous arterial spin labeling (ASL) employs blood as an endogenous tracer by modifying its magnetization using radiofrequency fields, enabling non-invasive quantification of tissue perfusion according to images obtained by ASL or control labeling. D- Image Processing and Analysis: - Subcortical structures segmentation and quantification: The full automated post-processing analysis of the 3D T1-weighted MRI data was performed with Freesurfer version 7, a program for image analysis that is documented and available for free online download. - Cortical Thickness Analysis: Multiple deformable techniques were conducted to improve data processing and analysis upon completing the cortical models. These included surface inflation, registration to a spherical atlas using individual cortical folding patterns for alignment of cortical geometry across subjects, parcellation of the cerebral cortex into units according to gyral and sulcal structure, and the generation of diverse surface-based data, encompassing curvature and sulcal depth maps. The cortical thickness is measured after identifying cortical surfaces, which include the cortex, external structures (cortical CSF, pial surface, and background), and internal structures (deep gray and white matters). Subsequently, the paths running the internal and external boundaries are ascertained and their lengths measured. This method utilizes intensity and continuity information from the entire 3D MR volume to facilitate segmentation and deformation techniques, ultimately producing cortical thickness representations. The thickness is determined by measuring the minimum distance from the gray-white matter boundary to the gray-CSF boundary at each vertex on the tessellated surface. The maps are produced using spatial intensity gradients across various tissue types and are therefore not just reliant on absolute signal intensity. The produced maps are not restricted by the voxel resolution of the original data, hence detecting submillimeter variations across groups 7 . 2.3 Statistical analysis: Data were analyzed with Statistical Program for Social Science (SPSS) version 24. Quantitative data were expressed as mean ±SD. Qualitative data were expressed as frequency and percentage. Chi-square test was deployed to compare between non-parametric data. P-value < 0.05 was considered significant. 3. RESULTS Among the 30 included patients, the mean age was 8.2 ± 3.6 years, ranging from 2 to 17 years. The cohort comprised 14 males (46.7%) and 16 females (53.3%). Clinical data of all patients is described in table 1. Results of Inter-ictal EEG monitoring revealed that; there were 14 patients (46.7%) with focal paroxysmal discharges on right side, 14 patients (46.7%) on left side and 2 (6.7%) patients had bilateral paroxysmal discharges. Frontal lobe was affected in 6 patients (20%), temporal lobe was affected in 7 patients (23.3%) while it was multi-focal in 17 patients (56.7%) . The IOZ was observed in all studies patients throughout long-term video-EEG monitoring and the findings are described in table 2. Structural brain MRI was done for all patients and the findings (Focal brain lesions) are described in table 3. Volumetric studies were done on 27 patients and their findings (Hypovolemia) are described in table 4. Arterial Spin Labeling sequences were done for 28 patients and their findings (hypoperfusion) are described in table 5. Brain PET scans were done for 10 patients and their findings (hypometabolism) are described in table 6. In comparing these results, we found that there was concordance between Ictal EEG and Inter-ictal EEG regarding the affected side, and the affected lobe as there was lack of statistical significance between both results (p-value = 0.964, 0.126 respectively). There was concordance between sMRI brain and inter-ictal EEG regarding the affected side, as there was no statistically significant difference between both results (p-value = 0.824). Nevertheless, there was a statistically significant difference between results of sMRI brain and inter-ictal EEG regarding the affected lobe and this finding denies their concordance (Table 7). On the other hand, there was concordance between sMRI brain and Ictal EEG regarding the affected side and the affected lobe as no statistically significant difference between their results was observed (p-value = 0.887, and 0.24) respectively (Figure 1 &2). In comparison of sMRI and ASL, there was concordance between both tests regarding the affected side and the affected lobe ( p-value=0.212 and 0.265 respectively) (Table 8). Regarding the correlation between ictal EEG and ASL findings, it is shown in table 9 that a statistically significant difference between both tests regarding the affected lobe but not the affected side was found. This denies their concordance regarding the affected lobe. Regarding the results of brain volumetry, we found that there was concordance between volumetric studies and sMRI brain findings regarding both the side and the affected lobe as there was no statistical significance between both tests (Figure 3 &4). Regarding results of PET and ASL, we confirmed their concordance (table 10) 4. Discussion Video-EEG monitoring is the gold-standard modality for diagnosing DRE; the synchronous display of the ictal EEG pattern and paroxysmal behavior provides high precision in syndromic epilepsy classification, localization of interictal discharges, differentiation between true DRE and NEEE, and the IOZ localization 8 . Here, thirty focal DRE patients were enrolled and assessed using 6–24-h long term video-EEG monitoring to delineate the ictal and inter-ictal EEG patterns of their seizures’ electrical activity. In comparison of ictal and inter-ictal EEG, no statistically significant difference between the IOZ and the inter-ictal focal paroxysmal discharges localized by video-EEG was observed as regard the affected side nor the affected lobe which confirms their concordance. Our findings come in partial agreement with those of Cendes et al., as a robust association was identified between ictal and interictal scalp EEG lateralization, as well as between each of these two EEG datasets and MRI lateralization, in 184 consecutive Temporal lobe epilepsy (TLE) patients 9 . Brain imaging is an essential step in the preoperative assessment of epilepsy patients. Specific protocols have been recommended to improve the efficacy of MRI in refractory epilepsy patients’ assessment. The suggested sequences include T1-weighted sagittal 3D and 3D FLAIR sequences, coronal T2-weighted images (perpendicular to the hippocampus), diffusion-weighted images, and axial susceptibility-weighted images 10 . In this study, 30 patients with focal DRE underwent sMRI brain imaging following the proposed epilepsy protocol. MRI epilepsy protocol was successful in detecting a focal structural brain lesion in 29 patients out of the studied 30 patients. Our findings align with those of Semah et al., who conducted a research including 2,200 epilepsy patients at a tertiary care center, categorized according to ILAE criteria. Herein, 1,369 patients (62.2%) manifested localization-associated epilepsy. Among them, 66% exhibited TLE, 24% revealed frontal epilepsy, 2% with parietal epilepsy, 3% with occipital epilepsy, and 3% with multi-lobar epilepsy, underscoring that temporal lobe epilepsy is the predominant reason of lesional epilepsy, followed by frontal lobe epilepsy 11 . Adamczyk et al. demonstrated that temporal sclerosis and focal cortical dysplasia were the predominant brain structural abnormalities identified by neuroimaging in focal epilepsy patients. Subsequently, tuberous sclerosis complex, low-grade gliomas, vascular malformations, and hypothalamic hamartomas. Rasmussen's encephalitis is rarely found 12 . This comes in partial agreement with the current results as regard the nature of lesions suggested by sMRI brain images. We found gliosis in 12 patients (40%) denoting old focal brain insult, followed by temporal sclerosis in 9 patients (30%) and FCD in 8 patients (26.7%) while it was normal in 1 patient (3.3%). We are emphasizing on the great utility of ASL in pediatric focal DRE during presurgical evaluation. Twenty-eight patients underwent ASL testing, their findings revealed that it was successful in detecting focal hypoperfusion abnormalities in 23 patients out of the studied 28 patients. In comparison of ASL with sMRI brain findings, their findings were concordant. This comes in concordance with the findings of Sierra et al. study that included 25 patients, 18 individuals (72%) exhibited lesions on structural MRI. Abnormalities in ASL were found in 15 (60%) patients. ASL exhibited a strong agreement with FDG-PET (k = 0.84), a good consistency with structural MRI (k = 0.76), a modest alignment with video-EEG monitoring (k = 0.53), and a fair concordance with SISCOM (k = 0.28) 13 . Additionally, these outcomes align with those of Lee et al., who studied 43 patients (17 males and 26 females, 6.3 ± 3.3 years) with newly diagnosed epilepsy, revealing that the seizure type was focal in 36 patients and generalized in seven subjects. Among 36 focal seizures patients, 24 (66.7%) had abnormalities in ASL, whereas 19 (52.8%) demonstrated congruence between ASL and EEG results. He determined that the integration of ASL with EEG and structural MRI may significantly contribute to the assessment of pediatric epilepsy 14 . The children are more sensitive to ASL acquisition contrasted with adults. Elevated CBF and raised blood velocity in the carotid artery, in comparison to adults, lead to decreased relaxation time and transit effects. Furthermore, the brain's water content is greater in children. This leads to an elevated equilibrium MR signal and enhances pediatric ASL signal by elevating tracer concentration and lifetime 15 . In this study, twenty-seven patients underwent volumetry. Our findings revealed that volumetry was successful in detecting focal hypovolemia in 22 patients out of the studied 27 patients. In comparison between volumetry and sMRI brain, both results were concordant. This further supports the results of Keller et al., who reviewed 18 PubMed publications of brain volumetric studies in TLE patients up to May 2007. Several studies revealed significantly mitigated 26 brain regions volume compared to healthy controls. A strong asymmetrical distribution of temporal lobe abnormalities was mostly found ipsilateral to the seizure site, especially involving the hippocampus (82.35% of all studies), parahippocampal gyrus (7.06%), and entorhinal cortex (23.52%) 16 . Conclusion: The multimodality patients approach in this work approved the utility of new techniques such as ASL and volumetry as a powerful indicator of the epileptogenic lesion especially when integrated with concordant data from interictal and ictal scalp EEG and structural MRI. Abbreviations 3D Three-dimensional ADHD Attention deficit hyperactive disorder ASM Anti-seizure medications CNS Central nervous system DRE Drug resistant epilepsy ECG Electrocardiogram EEG Electroencephalogram EZ Epileptic zone FLAIR Fluid-attenuated inversion recovery IOZ Ictal onset zone sMRI Structural Magnetic Resonance Imaging SPSS Statistical Program for Social Science TLE Temporal lobe epilepsy Declarations Ethics Approval and Consent to participate Ethical permission to carry out the study was sought from the hospital’s Health Research Ethics Committee (HREC) before the commencement of the study (Code: MD-87-2022). Detailed information, explanation and nature of the study were offered to the parents of the selected subjects who were eligible for the study and an informed written consent was obtained for participation and publication of the study. Each participant was given the opportunity to ask questions about the study and appropriate answers were provided. Funding for the study The funding for the study was provided solely by the researcher. The researcher is the only funding body for the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. Author Contribution Y.S and B.I wrote the main manuscript. M.R and M.B reviewed the radiological techniques. A.M, H.E and I.E helped with interpretation of results. M.Y and W.E reviewed and edited all parts of the manuscript. All authors reviewed the manuscript. Data Availability Data is provided within the manuscript. References Kwan, P., Arzimanoglou, A., Berg, A.T., Brodie, M.J., Allen Hauser, W., Mathern, G., Moshé, S.L., Perucca, E., Wiebe, S. and French, J., (2010). Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Dwivedi, R., Ramanujam, B., Chandra, P.S., Sapra, S., Gulati, S., Kalaivani, M., Garg, A., Bal, C.S., Tripathi, M., Dwivedi, S.N. and Sagar, R., (2017). Surgery for drug-resistant epilepsy in children. New England Journal of Medicine, 377(17), 1639-1647. Cascino, G.D., (2002 ) . Video‐EEG monitoring in adults. Epilepsia; 43:80-93. Nagesh, C., Kumar, S., Menon, R., Thomas, B., Radhakrishnan, A. and Kesavadas, C., (2018). The imaging of localization related symptomatic epilepsies: the value of arterial spin labelling based magnetic resonance perfusion. Korean journal of radiology; 19(5), 965-977. Halford, J.J., Sabau, D., Drislane, F.W., Tsuchida, T.N. and Sinha, S.R., (2016). American clinical neurophysiology society guideline 4: recording clinical EEG on digital media. The Neurodiagnostic Journal; 56(4): 261-265. Cendes, F., Theodore, WH., Brinkmann, BH., Sulc, V., Cascino, GD., (2016). Neuroimaging of epilepsy. Handbook of Clinical Neurology; 136:985–1014. Salat, D.H., Lee, S.Y., Van der Kouwe, A.J., Greve, D.N., Fischl, B. and Rosas, H.D., (2009) . Age-associated alterations in cortical gray and white matter signal intensity and gray to white matter contrast. Neuroimage; 48(1): 21-28. Eissa, A. A. N., Bahnasy, W. S., Salama, A. S. A. A. E., Eldin, E. A. M. T., & Fayed, H. A., (2019). Long-term EEG monitoring and positron emission tomography in evaluating patients with drug-resistant epilepsy. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery , 55, 1-7. Cendes, F., Li, L.M., Watson, C., Andermann, F., Dubeau, F. and Arnold, D.L., (2000). Is ictal recording mandatory in temporal lobe epilepsy? Not when the interictal electroencephalogram and hippocampal atrophy coincide. Archives of neurology; 57(4):497-500. Duncan, J. S. (2010). Imaging in the surgical treatment of epilepsy. Nature Reviews Neurology, 6(10), 537-550. Semah, F., Picot, M.C., Adam, C., Broglin, D., Arzimanoglou, A., Bazin, B., Cavalcanti, D. and Baulac, M., (1998). “Is the underlying cause of epilepsy a major prognostic factor for recurrence?” Neurology; vol. 51, no. 5, 1256–1262. Adamczyk, B., Węgrzyn, K., Wilczyński, T., Maciarz, J., Morawiec, N. and Adamczyk-Sowa, M., (2021). The most common lesions detected by neuroimaging as causes of epilepsy. Medicina; 57(3): 294. Sierra‐Marcos, A., Carreño, M., Setoain, X., López‐Rueda, A., Aparicio, J., Donaire, A. and Bargalló, N., (2016). 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Tables Table 1: Clinical data of all studied patients Studied patients (N = 30) Onset of fits (years) Mean ±SD 2.8 ± 5.4 Min - Max 0.1 – 10 Frequency before medications (No of fits/ week) Mean ±SD 28.1 ± 25.1 Min - Max 1 – 90 Seizure duration (min) Mean ±SD 3.7 ± 4.1 Min - Max 1 – 20 Time elapsed from last fit (days) Mean ±SD 3.5 ± 3.9 Min - Max 1 – 20 Table 2 : Ictal EEG findings in the studied cohort Studied patients (N = 30) Side Right 15 50% Left 13 43.3% Bilateral 2 6.7% Affected lobe Frontal 10 33.3% Temporal 9 30% Parietal 2 6.7% Multi-focal 9 30.0% Table 3: Findings of sMRI brain in the studied cohort Studied patients (N = 30) Side None 1 3.3% Right 14 46.7% Left 12 40% Bilateral 3 10% Affected lobe None 1 3.3% Frontal 9 30% Temporal 12 40% Parietal 3 10% Hemisphere 2 6.7% Multi-focal 3 10% Nature Normal 1 3.3% FCD 8 26.7% Gliosis 12 40% Mesial Sclerosis 9 30% Table4: Findings of Volumetry studies in the studied cohort Studied patients (N = 27) Side Right 16 59.3% Left 10 37% Bilateral 1 3.7% Affected lobe None 5 18.5% Frontal 8 29.6% Temporal 11 40.7% Parietal 0 0% Hemisphere 2 7.4% Multi-focal 1 3.7% Table 5: ASL findings in studied cohort Studied patients (N = 28) Side Right 17 60.7% Left 11 39.3% Bilateral 0 0% Affected lobe None 5 17.9% Frontal 6 21.4% Temporal 11 39.3% Parietal 0 0% Hemisphere 3 10.7% Multi-focal 3 10.7% Table 6: Brain PET scan findings in studied cohort Studied patients (N = 10) Side None 1 10% Right 7 70% Left 2 20% Affected lobe Normal 1 10% Frontal 3 30% Temporal 3 30% Parietal 1 10% Multi-focal 2 20% Table 7: Comparison between sMRI brain and Inter-Ictal EEG findings as regard the affected side and lobe sMRI (N = 30) Inter-Ictal EEG (N = 30) Stat. test P-value Side Right 15 50% 14 46.7% X 2 = 0.38 0.824 NS Left 12 40% 14 46.7% Bilateral 3 10% 2 6.7% Lobe None 1 3.3% 0 0% X 2 = 17.7 0.003 S Frontal 9 30% 6 20% Temporal 12 40% 7 23.3% Parietal 3 10% 0 0% Hemisphere 2 6.7% 0 0% Multi-focal 3 10% 17 56.7% Table 8: Comparison between sMRI brain and ASL as regard the affected side and lobe sMRI (N = 30) ASL (N = 28) Stat. test P-value Side Right 15 50% 17 60.7% X 2 = 3.1 0.212 NS Left 12 40% 11 39.3% Bilateral 3 10% 0 0% Lobe None 1 3.3% 5 17.9% X 2 = 6.4 0.265 NS Frontal 9 30% 6 21.4% Temporal 12 40% 11 39.3% Parietal 3 10% 0 0% Hemisphere 2 6.7% 3 10.7% Multi-focal 3 10% 3 10.7% Table 9: Comparison between Ictal EEG and ASL as regard the affected side and lobe Ictal EEG (N = 30) ASL (N = 28) Stat. test P-value Side Right 15 50% 17 60.7% X 2 = 2.22 0.329 NS Left 13 43.3% 11 39.3% Bilateral 2 6.7% 0 0% Lobe None 0 0% 5 17.9% X 2 = 14.1 0.015 S Frontal 10 33.3% 6 21.4% Temporal 9 30% 11 39.3% Parietal 2 6.7% 0 0% Hemisphere 0 0% 3 10.7% Multi-focal 9 30% 3 10.7% Table 10: Comparison between PET scan and ASL as regard the affected side and lobe PET scan (N = 10) ASL (N = 28) Stat. test P-value Side Right 8 80% 17 60.7% X 2 = 1.2 0.270 NS Left 2 20% 11 39.3% Lobe None 1 10% 5 17.9% X 2 = 5.04 0.411 NS Frontal 3 30% 6 21.4% Temporal 3 30% 11 39.3% Parietal 1 10% 0 0% Hemisphere 0 0% 3 10.7% Multi-focal 2 20% 3 10.7% Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 22 Jul, 2025 Read the published version in Egyptian Pediatric Association Gazette → Version 1 posted Editorial decision: Accepted 26 Jun, 2025 Reviews received at journal 26 Jun, 2025 Reviewers agreed at journal 13 Jun, 2025 Reviewers agreed at journal 22 May, 2025 Reviews received at journal 16 May, 2025 Reviewers agreed at journal 05 May, 2025 Reviewers agreed at journal 17 Apr, 2025 Reviewers agreed at journal 01 Apr, 2025 Reviewers agreed at journal 13 Feb, 2025 Reviewers invited by journal 13 Feb, 2025 Editor assigned by journal 13 Feb, 2025 Submission checks completed at journal 13 Feb, 2025 First submitted to journal 09 Feb, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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12:08:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5992280/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5992280/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s43054-025-00403-5","type":"published","date":"2025-07-22T15:57:36+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":76573920,"identity":"fb69ef6e-b2cc-452e-9636-72c5d3b81a70","added_by":"auto","created_at":"2025-02-18 14:01:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":79803,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison between sMRI brain and Ictal EEG findings as regard the affected side\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5992280/v1/9f062642d8d6aba210fa9caf.png"},{"id":76572636,"identity":"422731d8-f8fb-45ba-b94d-8dcf8836096e","added_by":"auto","created_at":"2025-02-18 13:53:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":87534,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison between sMRI brain and Ictal EEG findings as regard the affected lobe\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5992280/v1/a249507772a661001258565c.png"},{"id":76572634,"identity":"088f4174-f66b-4cd0-83a3-6129ee76d933","added_by":"auto","created_at":"2025-02-18 13:53:14","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":61380,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison between sMRI brain and Volumetry as regard the affected side\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5992280/v1/8f2440db2eef5e71d231d4f1.png"},{"id":76572647,"identity":"30dd43a2-f002-433b-a7e6-d63757834415","added_by":"auto","created_at":"2025-02-18 13:53:15","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":89605,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison between sMRI brain and Volumetry as regard the affected lobe\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5992280/v1/a0f69ce4017b98aa3bc97da7.png"},{"id":87756920,"identity":"b6acde39-6870-4fdf-9d08-c056960296ad","added_by":"auto","created_at":"2025-07-28 16:10:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2726694,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5992280/v1/d7192e16-902a-4239-9b74-b5e89a50c722.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison between old and new imaging modalities in the presurgical evaluation of children with intractable epilepsy","fulltext":[{"header":"1. Background","content":"\u003cp\u003eDrug-resistant epilepsy (DRE) is marked by the failure of adequate trials with two well selected anti-seizure medications (ASM) with tolerable side effects \u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e.\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eChildren and adolescents diagnosed with DRE have heightened risk for worse long-term intellectual and psychosocial outcomes. In this kind of resistant epilepsy, suitable surgical intervention is often performed to diminish or stop seizures\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe video-EEG monitoring is utilized to perform presurgical evaluation; the simultaneous measurement of the ictal EEG pattern and paroxysmal behavior may validate the seizure disorder diagnosis, evaluate seizure frequency and precipitating factors, categorize seizure types, and aid in surgical localization\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn addition to structural magnetic resonance imaging (sMRI), The epileptic zone (EZ) delineation has traditionally been performed using EEG and nuclear imaging modalities. Arterial spin labeling (ASL) sequence is a non-contrast magnetic resonance perfusion technique that can provide comparable information. Its efficacy in epilepsy is contingent upon changing seizure activity-related perfusion through the neurovascular coupling \u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHere, we aimed to describe the possible correlations between long term video EEG monitoring and multiple neuro-imaging techniques, and to compare old imaging modalities as sMRI brain and FDG-PET scans with new emerging techniques as brain volumetry studies and ASL sequences during the presurgical assessment of focal DRE.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eThis is a prospective observational analytical cohort study. Patients were recruited from November 2021 till May 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1 Study Population:\u003c/strong\u003e Thirty patients below 18 years of age who suffered from intractable focal epilepsy evident by seizure semiology and were on more than 2 antiepileptic drugs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEnrolled cases underwent comprehensive history collection and thorough general and neurological examinations to exclude any generalized systemic illness and identify any associated CNS disorders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Presurgical evaluation via\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA-\u003c/strong\u003e long-term video EEG monitoring to evaluate and localize ictal onset zones (IOZ). Patients underwent long-term EEG video recording lasting 6 to 24 hours, utilizing different EEG systems per the American Clinical Neurophysiology Society guidelines\u003cstrong\u003e\u003csup\u003e5\u0026nbsp;\u003c/sup\u003e\u003csub\u003e.\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB-\u003c/strong\u003e\u0026nbsp; Magnetic resonance imaging (MRI) at 1.5 Tesla, incorporating an epilepsy protocol, which encompassed T1-weighted sagittal three-dimensional (3D) and 3D fluid-attenuated inversion recovery (FLAIR) sequences with 1 mm-slice thickness isotropic resolution and no intervening gap, coronal T2-weighted images with a 2.5-mm slice thickness and no gap (perpendicular to the hippocampus), diffusion-weighted images, and axial susceptibility-weighted images. The procedure used a 1.5-T MRI machine, specifically a\u0026nbsp;1.5 Tesla GE SIGNA closed-configuration whole body scanner, with\u0026nbsp;a standard\u0026nbsp;quadrature head coil.\u0026nbsp;Siemens, software version syngo MR E 11, according to the epilepsy imaging protocol established by Cendes and colleagues \u003cstrong\u003e\u003csup\u003e6\u003c/sup\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC-\u003c/strong\u003e\u0026nbsp; \u0026nbsp;3D pseudo-continuous arterial spin labeling (ASL) employs\u0026nbsp;blood as an endogenous\u0026nbsp;tracer\u0026nbsp;by modifying\u0026nbsp;its magnetization\u0026nbsp;using\u0026nbsp;radiofrequency\u0026nbsp;fields, enabling\u0026nbsp;non-invasive\u0026nbsp;quantification\u0026nbsp;of tissue perfusion\u0026nbsp;according to\u0026nbsp;images\u0026nbsp;obtained by\u0026nbsp;ASL or control labeling.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eD-\u0026nbsp;\u003c/strong\u003e\u0026nbsp; Image Processing and Analysis:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; - \u003cstrong\u003eSubcortical structures segmentation and quantification:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe full automated\u0026nbsp;post-processing analysis of the 3D T1-weighted MRI data was performed with\u0026nbsp;Freesurfer version 7, a program for image analysis that is documented and available for free online download.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u0026nbsp; \u0026nbsp;\u003cstrong\u003eCortical Thickness Analysis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultiple deformable techniques were conducted to improve data processing and analysis upon completing the cortical models. These included surface inflation, registration to a spherical atlas using individual cortical folding patterns for alignment of cortical geometry across subjects, parcellation of the cerebral cortex into units according to gyral and sulcal structure, and the generation of diverse surface-based data, encompassing curvature and sulcal depth maps.\u003c/p\u003e\n\u003cp\u003eThe cortical thickness is measured\u0026nbsp;after identifying cortical surfaces, which include the cortex, external structures (cortical CSF, pial surface, and background), and internal structures (deep gray and white matters). Subsequently, the paths running\u0026nbsp;the internal and external boundaries are ascertained and their lengths measured.\u003c/p\u003e\n\u003cp\u003eThis method utilizes intensity and continuity information from the entire 3D MR volume to facilitate segmentation and deformation techniques, ultimately producing cortical thickness representations. The thickness is determined by measuring the minimum distance from the gray-white matter boundary to the gray-CSF boundary at each vertex on the tessellated surface.\u003c/p\u003e\n\u003cp\u003eThe maps are produced using spatial intensity gradients across various tissue types and are therefore not just reliant on absolute signal intensity. The produced maps are not restricted by the voxel resolution of the original data, hence detecting submillimeter variations across groups\u003cstrong\u003e\u003csup\u003e7\u003c/sup\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Statistical analysis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed with Statistical Program for Social Science (SPSS) version 24. \u0026nbsp; Quantitative data were expressed as mean \u0026plusmn;SD. Qualitative data were expressed as frequency and percentage. Chi-square test was deployed to compare between non-parametric data. P-value \u0026lt; 0.05 was considered significant.\u003c/p\u003e"},{"header":"3. RESULTS","content":"\u003cp\u003eAmong the 30 included patients, the \u003cstrong\u003emean age\u003c/strong\u003e was 8.2 \u0026plusmn; 3.6 years, ranging from 2 to 17 years. The cohort comprised 14 \u003cstrong\u003emales\u003c/strong\u003e (46.7%) and 16 \u003cstrong\u003efemales\u003c/strong\u003e (53.3%). Clinical data of all patients is described in table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults of Inter-ictal EEG monitoring revealed that; there were 14 patients (46.7%) with focal paroxysmal discharges on right side, 14 patients (46.7%) on left side and 2 (6.7%) patients had bilateral paroxysmal discharges. Frontal lobe was affected in 6 patients (20%), temporal lobe was affected in 7 patients (23.3%) while it was multi-focal in 17 patients (56.7%) .\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe IOZ was observed in all studies patients throughout long-term video-EEG monitoring and the findings are described in table 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStructural brain MRI was done for all patients and the findings (Focal brain lesions) are described in table 3.\u003c/p\u003e\n\u003cp\u003eVolumetric studies were done on 27 patients and their findings (Hypovolemia) are described in table 4.\u003c/p\u003e\n\u003cp\u003eArterial Spin Labeling sequences were done for 28 patients and their findings (hypoperfusion) are described in table 5.\u003c/p\u003e\n\u003cp\u003eBrain PET scans were done for 10 patients and their findings (hypometabolism) are described in table 6.\u003c/p\u003e\n\u003cp\u003eIn comparing these results, we found that there was concordance between Ictal EEG and Inter-ictal EEG regarding the affected side, and the affected lobe as there was lack of statistical significance between both results (p-value = 0.964, 0.126 respectively).\u003c/p\u003e\n\u003cp\u003eThere was concordance between sMRI brain and inter-ictal EEG regarding the affected side, as there was no statistically significant difference between both results (p-value = 0.824). Nevertheless, there was a statistically significant difference between results of \u0026nbsp;sMRI brain and inter-ictal EEG regarding the affected lobe and this finding denies their concordance (Table 7).\u003c/p\u003e\n\u003cp\u003eOn the other hand, there was concordance between sMRI brain and Ictal EEG regarding the affected side \u0026nbsp; and the affected lobe as no statistically significant difference between their results was observed (p-value = 0.887, and 0.24) respectively (Figure 1 \u0026amp;2).\u003c/p\u003e\n\u003cp\u003eIn comparison of sMRI and ASL, there was concordance between both tests regarding the affected side and the affected lobe ( p-value=0.212 and 0.265 respectively) (Table 8).\u003c/p\u003e\n\u003cp\u003eRegarding the correlation between ictal EEG and ASL findings, it is shown in table 9 that a statistically significant difference between both tests \u0026nbsp;regarding the affected lobe but not the affected side was found. This denies their concordance regarding the affected lobe.\u003c/p\u003e\n\u003cp\u003eRegarding the results of brain volumetry, we found that there was concordance between volumetric studies and sMRI brain findings regarding both the side and the affected lobe as there was no statistical significance between both tests (Figure 3 \u0026amp;4).\u003c/p\u003e\n\u003cp\u003eRegarding results of PET and ASL, we confirmed their concordance (table 10)\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eVideo-EEG monitoring is the gold-standard modality for diagnosing DRE; the synchronous display of the ictal EEG pattern and paroxysmal behavior provides high precision in syndromic epilepsy classification, localization of interictal discharges, differentiation between true DRE and NEEE, and the IOZ localization\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHere, thirty focal DRE patients were enrolled and assessed using 6\u0026ndash;24-h long term video-EEG monitoring to delineate the ictal and inter-ictal EEG patterns of their seizures\u0026rsquo; electrical activity.\u003c/p\u003e \u003cp\u003eIn comparison of ictal and inter-ictal EEG, no statistically significant difference between the IOZ and the inter-ictal focal paroxysmal discharges localized by video-EEG was observed as regard the affected side nor the affected lobe which confirms their concordance.\u003c/p\u003e \u003cp\u003eOur findings come in partial agreement with those of Cendes et al., as a robust association was identified between ictal and interictal scalp EEG lateralization, as well as between each of these two EEG datasets and MRI lateralization, in 184 consecutive Temporal lobe epilepsy (TLE) patients\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBrain imaging is an essential step in the preoperative assessment of epilepsy patients. Specific protocols have been recommended to improve the efficacy of MRI in refractory epilepsy patients\u0026rsquo; assessment. The suggested sequences include T1-weighted sagittal 3D and 3D FLAIR sequences, coronal T2-weighted images (perpendicular to the hippocampus), diffusion-weighted images, and axial susceptibility-weighted images\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn this study, 30 patients with focal DRE underwent sMRI brain imaging following the proposed epilepsy protocol. MRI epilepsy protocol was successful in detecting a focal structural brain lesion in 29 patients out of the studied 30 patients.\u003c/p\u003e \u003cp\u003eOur findings align with those of Semah et al., who conducted a research including 2,200 epilepsy patients at a tertiary care center, categorized according to ILAE criteria. Herein, 1,369 patients (62.2%) manifested localization-associated epilepsy. Among them, 66% exhibited TLE, 24% revealed frontal epilepsy, 2% with parietal epilepsy, 3% with occipital epilepsy, and 3% with multi-lobar epilepsy, underscoring that temporal lobe epilepsy is the predominant reason of lesional epilepsy, followed by frontal lobe epilepsy \u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAdamczyk et al. demonstrated that temporal sclerosis and focal cortical dysplasia were the predominant brain structural abnormalities identified by neuroimaging in focal epilepsy patients. Subsequently, tuberous sclerosis complex, low-grade gliomas, vascular malformations, and hypothalamic hamartomas. Rasmussen's encephalitis is rarely found \u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e. This comes in partial agreement with the current results as regard the nature of lesions suggested by sMRI brain images. We found gliosis in 12 patients (40%) denoting old focal brain insult, followed by temporal sclerosis in 9 patients (30%) and FCD in 8 patients (26.7%) while it was normal in 1 patient (3.3%).\u003c/p\u003e \u003cp\u003eWe are emphasizing on the great utility of ASL in pediatric focal DRE during presurgical evaluation. Twenty-eight patients underwent ASL testing, their findings revealed that it was successful in detecting focal hypoperfusion abnormalities in 23 patients out of the studied 28 patients.\u003c/p\u003e \u003cp\u003eIn comparison of ASL with sMRI brain findings, their findings were concordant. This comes in concordance with the findings of Sierra et al. study that included 25 patients, 18 individuals (72%) exhibited lesions on structural MRI. Abnormalities in ASL were found in 15 (60%) patients. ASL exhibited a strong agreement with FDG-PET (k\u0026thinsp;=\u0026thinsp;0.84), a good consistency with structural MRI (k\u0026thinsp;=\u0026thinsp;0.76), a modest alignment with video-EEG monitoring (k\u0026thinsp;=\u0026thinsp;0.53), and a fair concordance with SISCOM (k\u0026thinsp;=\u0026thinsp;0.28)\u003csup\u003e13\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAdditionally, these outcomes align with those of Lee et al., who studied 43 patients (17 males and 26 females, 6.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 years) with newly diagnosed epilepsy, revealing that the seizure type was focal in 36 patients and generalized in seven subjects. Among 36 focal seizures patients, 24 (66.7%) had abnormalities in ASL, whereas 19 (52.8%) demonstrated congruence between ASL and EEG results. He determined that the integration of ASL with EEG and structural MRI may significantly contribute to the assessment of pediatric epilepsy \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe children are more sensitive to ASL acquisition contrasted with adults. Elevated CBF and raised blood velocity in the carotid artery, in comparison to adults, lead to decreased relaxation time and transit effects. Furthermore, the brain's water content is greater in children. This leads to an elevated equilibrium MR signal and enhances pediatric ASL signal by elevating tracer concentration and lifetime \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn this study, twenty-seven patients underwent volumetry. Our findings revealed that volumetry was successful in detecting focal hypovolemia in 22 patients out of the studied 27 patients. In comparison between volumetry and sMRI brain, both results were concordant.\u003c/p\u003e \u003cp\u003eThis further supports the results of Keller et al., who reviewed 18 PubMed publications of brain volumetric studies in TLE patients up to May 2007. Several studies revealed significantly mitigated 26 brain regions volume compared to healthy controls. A strong asymmetrical distribution of temporal lobe abnormalities was mostly found ipsilateral to the seizure site, especially involving the hippocampus (82.35% of all studies), parahippocampal gyrus (7.06%), and entorhinal cortex (23.52%) \u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eConclusion: The multimodality patients approach in this work approved the utility of new techniques such as ASL and volumetry as a powerful indicator of the epileptogenic lesion especially when integrated with concordant data from interictal and ictal scalp EEG and structural MRI.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e3D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThree-dimensional\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eADHD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAttention deficit hyperactive disorder\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eASM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnti-seizure medications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eCNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCentral nervous system\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eDRE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrug resistant epilepsy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eECG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eElectrocardiogram\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEEG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eElectroencephalogram\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eEZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEpileptic zone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eFLAIR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFluid-attenuated inversion recovery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eIOZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIctal onset zone\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003esMRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStructural Magnetic Resonance Imaging\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eSPSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistical Program for Social Science\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eTLE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 456px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTemporal lobe epilepsy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics Approval and Consent to participate\u003c/h2\u003e\n\u003cp\u003eEthical permission to carry out the study was sought from the hospital\u0026rsquo;s Health Research Ethics Committee (HREC) before the commencement of the study (Code: MD-87-2022).\u003c/p\u003e\n\u003cp\u003eDetailed information, explanation and nature of the study were offered to the parents of the selected subjects who were eligible for the study and an informed written consent was obtained for participation and publication of the study. Each participant was given the opportunity to ask questions about the study and appropriate answers were provided.\u003c/p\u003e\n\u003ch2\u003eFunding for the study\u003c/h2\u003e\n\u003cp\u003eThe funding for the study was provided solely by the researcher. The researcher is the only funding body for the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.\u0026nbsp;\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eY.S and B.I wrote the main manuscript. M.R and M.B reviewed the radiological techniques. A.M, H.E and I.E helped with interpretation of results. M.Y and W.E reviewed and edited all parts of the manuscript. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col class=\"decimal_type\"\u003e\n \u003cli\u003e\u003cstrong\u003eKwan, P., Arzimanoglou, A., Berg, A.T., Brodie, M.J., Allen Hauser, W., Mathern, G., Mosh\u0026eacute;, S.L., Perucca, E., Wiebe, S. and French, J., (2010).\u003c/strong\u003e Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eDwivedi, R., Ramanujam, B., Chandra, P.S., Sapra, S., Gulati, S., Kalaivani, M., Garg, A., Bal, C.S., Tripathi, M., Dwivedi, S.N. and Sagar, R., (2017).\u003c/strong\u003e Surgery for drug-resistant epilepsy in children. New England Journal of Medicine, 377(17), 1639-1647.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCascino, G.D., (2002\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e Video‐EEG monitoring in adults. Epilepsia; 43:80-93.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eNagesh, C., Kumar, S., Menon, R., Thomas, B., Radhakrishnan, A. and Kesavadas, C., (2018).\u0026nbsp;\u003c/strong\u003eThe imaging of localization related symptomatic epilepsies: the value of arterial spin labelling based magnetic resonance perfusion. Korean journal of radiology; 19(5), 965-977.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eHalford, J.J., Sabau, D., Drislane, F.W., Tsuchida, T.N. and Sinha, S.R., (2016).\u003c/strong\u003e American clinical neurophysiology society guideline 4: recording clinical EEG on digital media. The Neurodiagnostic Journal; 56(4): 261-265.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCendes, F., Theodore, WH., Brinkmann, BH., Sulc, V., Cascino, GD., (2016).\u003c/strong\u003e Neuroimaging of epilepsy. Handbook of Clinical Neurology; 136:985\u0026ndash;1014.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;\u003cstrong\u003eSalat, D.H., Lee, S.Y., Van der Kouwe, A.J., Greve, D.N., Fischl, B. and Rosas, H.D., (2009)\u003c/strong\u003e. Age-associated alterations in cortical gray and white matter signal intensity and gray to white matter contrast.\u0026nbsp;Neuroimage; 48(1): 21-28.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eEissa, A. A. N., Bahnasy, W. S., Salama, A. S. A. A. E., Eldin, E. A. M. T., \u0026amp; Fayed, H. A., (2019).\u0026nbsp;\u003c/strong\u003eLong-term EEG monitoring and positron emission tomography in evaluating patients with drug-resistant epilepsy.\u0026nbsp;The Egyptian Journal of Neurology, Psychiatry and Neurosurgery\u003cstrong\u003e,\u0026nbsp;55, 1-7.\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCendes, F., Li, L.M., Watson, C., Andermann, F., Dubeau, F. and Arnold, D.L., (2000).\u003c/strong\u003e Is ictal recording mandatory in temporal lobe epilepsy? Not when the interictal electroencephalogram and hippocampal atrophy coincide. Archives of neurology; 57(4):497-500.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eDuncan, J. S. (2010). Imaging in the surgical treatment of epilepsy.\u0026nbsp;Nature Reviews Neurology,\u0026nbsp;6(10), 537-550.\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSemah, F., Picot, M.C., Adam, C., Broglin, D., Arzimanoglou, A., Bazin, B., Cavalcanti, D. and Baulac, M., (1998).\u003c/strong\u003e \u0026ldquo;Is the underlying cause of epilepsy a major prognostic factor for recurrence?\u0026rdquo; Neurology; vol. 51, no. 5, 1256\u0026ndash;1262.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAdamczyk, B., Węgrzyn, K., Wilczyński, T., Maciarz, J., Morawiec, N. and Adamczyk-Sowa, M., (2021).\u003c/strong\u003e The most common lesions detected by neuroimaging as causes of epilepsy. Medicina; 57(3): 294.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSierra‐Marcos, A., Carre\u0026ntilde;o, M., Setoain, X., L\u0026oacute;pez‐Rueda, A., Aparicio, J., Donaire, A. and Bargall\u0026oacute;, N., (2016).\u003c/strong\u003e Accuracy of arterial spin labeling magnetic resonance imaging (MRI) perfusion in detecting the epileptogenic zone in patients with drug‐resistant neocortical epilepsy: comparison with electrophysiological data, structural MRI, SISCOM and FDG‐PET. European Journal of Neurology; 23(1), 160-167.\u003c/li\u003e\n \u003cli\u003e14 \u003cstrong\u003eLee, S.M., Kwon, S. and Lee, Y.J., (2019)\u003c/strong\u003e. Diagnostic usefulness of arterial spin labeling in MR negative children with new onset seizures. Seizure; 65, 151-158.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eWang, J. and Licht, D.J., (2006).\u003c/strong\u003e Pediatric perfusion MR imaging using arterial spin labeling. Neuroimaging Clinics; 16(1), 149-167.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eKeller, S.S. and Roberts, N., (2008).\u003c/strong\u003e Voxel‐based morphometry of temporal lobe epilepsy: an introduction and review of the literature. Epilepsia, 49(5), 741-757.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Clinical data of all studied patients\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"540\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudied patients (N = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOnset of fits\u003c/strong\u003e \u003cstrong\u003e(years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e2.8 \u0026plusmn; 5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin - Max\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e0.1 \u0026ndash; 10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency before medications (No of fits/ week)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e28.1 \u0026plusmn; 25.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin - Max\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e1 \u0026ndash; 90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeizure duration\u003c/strong\u003e \u003cstrong\u003e(min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e3.7 \u0026plusmn; 4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin - Max\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e1 \u0026ndash; 20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime elapsed from last fit\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e3.5 \u0026plusmn; 3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin - Max\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e1 \u0026ndash; 20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eIctal EEG findings in the studied cohort\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"480\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 261px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudied patients (N = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSide\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e43.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBilateral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e6.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAffected lobe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrontal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTemporal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParietal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e6.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMulti-focal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e30.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Findings of sMRI brain in the studied cohort\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"507\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 292px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudied patients (N = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSide\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e3.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e46.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBilateral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAffected lobe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e3.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrontal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTemporal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParietal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemisphere\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e6.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMulti-focal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNature\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e3.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFCD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e26.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGliosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMesial Sclerosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable4: Findings of Volumetry studies \u0026nbsp;in the studied cohort\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"490\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudied patients (N = 27)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSide\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e59.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e37%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBilateral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e3.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAffected lobe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e18.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrontal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e29.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTemporal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e40.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParietal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemisphere\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e7.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMulti-focal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e3.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: ASL findings in studied cohort\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"486\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudied patients (N = 28)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSide\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e60.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e39.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBilateral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAffected lobe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNone\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e17.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrontal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e21.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTemporal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e39.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParietal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemisphere\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e10.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMulti-focal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e10.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eBrain PET scan findings in studied cohort\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"513\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 269px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudied patients (N = 10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSide\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e70%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAffected lobe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrontal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTemporal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParietal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMulti-focal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eComparison between sMRI brain and Inter-Ictal EEG findings as regard the affected side and lobe\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003esMRI\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInter-Ictal EEG\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStat. test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSide\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e46.7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eX\u003csup\u003e2\u003c/sup\u003e = 0.38\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.824 NS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e40%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e46.7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBilateral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLobe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.3%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eX\u003csup\u003e2\u003c/sup\u003e = 17.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003 S\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrontal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e20%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTemporal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e40%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e23.3%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParietal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemisphere\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMulti-focal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e56.7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eComparison between sMRI brain and ASL as regard the affected side and lobe\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003esMRI\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASL\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N = 28)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStat. test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSide\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e60.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e = 3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.212 NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e39.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBilateral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLobe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e17.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e = 6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.265 NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrontal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e21.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTemporal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e39.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParietal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemisphere\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e6.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e10.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMulti-focal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e10.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 9:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eComparison between Ictal EEG and ASL as regard the affected side and lobe\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIctal EEG (N = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASL (N = 28)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStat. test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSide\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e60.7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eX\u003csup\u003e2\u003c/sup\u003e = 2.22\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.329 NS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e43.3%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e39.3%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBilateral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLobe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17.9%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eX\u003csup\u003e2\u003c/sup\u003e = 14.1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.015 S\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrontal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e33.3%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e21.4%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTemporal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e39.3%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParietal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemisphere\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10.7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMulti-focal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10.7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 10: Comparison between PET scan and ASL as regard the affected side and lobe\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"590\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePET scan (N = 10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASL (N = 28)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStat. test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSide\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e60.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e = 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.270 NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e39.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLobe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e17.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e = 5.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.411 NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrontal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e21.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTemporal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e39.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParietal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemisphere\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e10.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMulti-focal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e10.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"egyptian-pediatric-association-gazette","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"epag","sideBox":"Learn more about [Egyptian Pediatric Association Gazette](https://epag.springeropen.com)","snPcode":"43054","submissionUrl":"https://submission.springernature.com/new-submission/43054/3?","title":"Egyptian Pediatric Association Gazette","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Focal Drug-resistant epilepsy, Presurgical evaluation, Video-EEG, MRI brain, Arterial spin labeling","lastPublishedDoi":"10.21203/rs.3.rs-5992280/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5992280/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Drug-resistant epilepsy is characterized by the failure of \u0026nbsp;adequate trials of two well selected anti-seizure drugs with tolerable side effects. Surgical intervention is often performed to mitigate or stop seizures. Different imaging techniques are used to evaluate those patients presurgically. Herein, we aimed to describe the correlation between seizure semiology, long term video-EEG and neuro-imaging modalities including high resolution three-dimensional structural brain MRI, ASL perfusion, brain volumetric analysis, and FDG-PET scans throughout the presurgical assessment of focal drug-resistant epilepsy patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology: \u003c/strong\u003eHere,\u003cstrong\u003e \u003c/strong\u003e30 patients fulfilled the inclusion criteria were included from our pediatric neurology clinic in a period from November 2021 till May 2023. History taking, full examination, 6–24-h long-term Video EEG recording (including ictal and inter-ictal recordings) and multiple neuro-imaging modalities were obtained from all patients. Thirty patients underwent structural MRI brain imaging, 27 patients underwent volumetry studies and 28 patients underwent magnetic resonance arterial spin labeling sequence. PET was done when no proper localization of seizures occurred (n=10).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Our multimodal methodology indicated that among patients with focal DRE, temporal lobe epilepsy was the prevailing, impacting 12 patients (40%), followed by frontal lobe epilepsy, impacting 9 patients (30%). There was concordance between Ictal EEG and Inter-ictal EEG regarding the affected side, and the affected lobe\u003cstrong\u003e. \u003c/strong\u003eWe also found concordance between\u003cstrong\u003e \u003c/strong\u003estructural MRI and ASL regarding the affected side and the affected lobe. In addition to between ASL, ictal EEG and PET scan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eFocal DRE patients necessitate meticulous multi-disciplinary assessment through detailed seizure semiology analysis, adequate long-term video EEG monitoring, and thorough neuro-imaging including already established techniques such as structural MRI and 18f-FDG PET brain scans and also new emerging techniques such as ASL and automated brain volumetry. Given the benefits of those new techniques regarding image quality, elevated accessibility, and the elimination of intravenous contrast agents, they are optimally suited for pediatric neuro-imaging during the pre-surgical evaluation of focal DRE.\u003c/p\u003e","manuscriptTitle":"Comparison between old and new imaging modalities in the presurgical evaluation of children with intractable epilepsy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-18 13:53:08","doi":"10.21203/rs.3.rs-5992280/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-06-26T16:02:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-26T14:30:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325177403058359082645756210420407596099","date":"2025-06-13T15:07:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"218286317261184350161256987964518239169","date":"2025-05-22T07:18:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-16T06:47:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"11349192424024255198160347460657109121","date":"2025-05-05T04:53:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"299578080879076600547186385508492391288","date":"2025-04-17T18:38:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"82958566004599968048193202490274542405","date":"2025-04-01T22:25:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"297121740408343331190358289079110463186","date":"2025-02-13T23:34:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-02-13T11:13:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-02-13T09:45:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-02-13T09:43:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"Egyptian Pediatric Association Gazette","date":"2025-02-09T12:00:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"egyptian-pediatric-association-gazette","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"epag","sideBox":"Learn more about [Egyptian Pediatric Association Gazette](https://epag.springeropen.com)","snPcode":"43054","submissionUrl":"https://submission.springernature.com/new-submission/43054/3?","title":"Egyptian Pediatric Association Gazette","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"91c47344-3315-4ed3-aa57-27251346cf7b","owner":[],"postedDate":"February 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-28T16:07:46+00:00","versionOfRecord":{"articleIdentity":"rs-5992280","link":"https://doi.org/10.1186/s43054-025-00403-5","journal":{"identity":"egyptian-pediatric-association-gazette","isVorOnly":false,"title":"Egyptian Pediatric Association Gazette"},"publishedOn":"2025-07-22 15:57:36","publishedOnDateReadable":"July 22nd, 2025"},"versionCreatedAt":"2025-02-18 13:53:08","video":"","vorDoi":"10.1186/s43054-025-00403-5","vorDoiUrl":"https://doi.org/10.1186/s43054-025-00403-5","workflowStages":[]},"version":"v1","identity":"rs-5992280","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5992280","identity":"rs-5992280","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}