HMPAO SPECT in non-epileptic seizures: preliminary results

Abstract

The diagnosis of non-epileptic seizures (NES) is problematic. Although diagnosis can be achieved by videotelemetry, these facilities are expensive and not widely available. HMPAO SPECT studies show focal hypoperfusion interictally in focal epilepsy. SPECT has not been studied in any detail in NES previously. Two groups (10 patients each) were studied, one with NES and one with complex partial seizures and localisation related epilepsy. SPECT scans were normal in 7 of 10 (70%) NES patients, while showing clear focal hypoperfusion in 8 of 10 patients (80%) with epilepsy. In the NES group, 1 patient showed hypoperfusion indistinguishable from that seen in epilepsy, while 2 patients in the epilepsy group showed only equivocal focal hypoperfusion. The remaining 2 patients in the NES group showed bifrontal and equivocal focal hypoperfusion. A normal HMPAO SPECT study supports the diagnosis of NES in patients with seizures of uncertain aetiology.

White matter diffusion abnormalities in patients with psychogenic non-epileptic seizures

“…A number of studies have described cases in which ictal/interictal-SPECT was performed on patients with PNES. In the majority of cases SPECT results were negative, and in some cases a positive result was found, though the locations were not consistent across studies (Biraben et al, 1999;Ettinger et al, 1998;Neiman et al, 2009;Spanaki et al, 1999;Varma et al, 1996). Another study reported that group analysis of patients with PNES revealed significant PET hypometabolism within the right inferior parietal and central area, and within the bilateral anterior cingulate cortex (Arthuis et al, 2014).…”

An Integrative Neurocircuit Perspective on Psychogenic Nonepileptic Seizures and Functional Movement Disorders

“…Quantitative SPECT, apart from a role in lesion localization for epilepsy surgery, has been used in cases where there is diagnostic uncertainty despite video EEG. 46 While ictal/interictal and subtraction SPECT are typically normal in PNES patients, 47 focal insular hypermetabolism on subtraction ictal SPECT 46 and bilateral frontal and right medial temporal lobe hypometabolism on inter-ictal SPECT 48 have been reported in PNES. Several studies have also described patients developing new-onset PNES or somatoform disorders following epilepsy surgery.…”

Psychogenic seizures and frontal disconnection: EEG synchronisation study

“…Preliminary interictal SPECT studies have shown a normal distribution of brain perfusion in PNES patients 10 11. Electroencephalographic approaches have been largely limited to routine clinical EEG and EEG-video monitoring considered as a gold standard for diagnostics 12 13.…”