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Ictal-interictal single photon emission computed tomography (SPECT) with co-registration to MRI (SISCOM) has proven its value in localizing epileptogenic zones [1–7]. This non-invasive tool remains crucial in challenging cases such as extra-temporal and/or non-lesional epilepsies [8]. Cerebral blood flow changes demonstrated during seizures reflect brain activation and its pathways of spread [9,10]. Its usefulness to establish sites for intracranial implantation and improve surgical outcome is now widely recognized [11,12].