Regional cerebral blood flow during focal seizures of temporal and frontocentral onset

Stefan, Hermann; Bauer, Jürgen; Feistel, H.; Schulemann, H.; Neubauer, U.; Wenzel, Beate; Wolf, F.; Neundörfer, B.; Huk, W.

doi:10.1002/ana.410270211

Cited by 120 publications

(53 citation statements)

References 9 publications

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“…Sensitivity ranged from 88.9% (ExT group) to 92.9% (TLE group) for ictal studies and from 76.7% (TLE group) to 78.3% (ExT group) for interictal studies, which is comparable to reported results for HMPAO 10,13,[26][27][28][29][30]. Also, specificity values of "mTc-ECD SPECT, ranging from 52.2% (ExT group, interictal studies) to 92.9% (TLE group, ictal studies), are similar to those found by Spencer (3) in a comprehensive meta-analysis of brain SPECT in epilepsy.…”

Section: Discussionsupporting

confidence: 85%

Localization of the Epileptogenic Zone by Ictal and Interictal SPECT with ^99mTc‐Ethyl Cysteinate Dimer in Patients with Medically Refractory Epilepsy

Oliveira¹,

Costa²,

Hilario

et al. 1999

Epilepsia

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Summary:Purpose: To evaluate the accuracy, feasibility and clinical value of both ictal and interictal y9"Tc-ethyl cysteinate dimer (ECD) single photon emission computed tomography (SPECT) in patients with medically refractory epilepsy.Methods: The study included 75 consecutive patients, 48 with temporal lobe epilepsy (TLE group), and 27 with extratemporal epilepsy (ExT group). The accuracy of SPECT was analyzed considering the final diagnosis reached by convergence of clinical, electrophysiologic, structural, pathologic and outcome data.Resulw Ictal SPECT correctly identified the epileptogenic zone in 21 (91.3%) of 23 patients, whereas interictal SPECTs could correctly identify the epileptogenic zone in only 41(62.1%) of 66 patients (x' = 5.56, df = 1, p < 0.05). Results were similar when the two study groups were analyzed separately. Moreover, ictal studies had significantly higher specificity (91.3 vs. 60.6%) and positive predictive value (91.3 vs.66.2%) than interictal studies for the whole series of patients. Considering all tools used in the preoperative workup of these patients, ictal SPECT significantly contributed to the final topographic diagnosis in seven of 14 patients from TLE group and in six of nine patients from the ExT group. In these patients, ictal SPECT either obviated the need for invasive EEG or helped to define where to concentrate the efforts of invasive investigation.Conclusions: These data demonstrate that ictal SPECT can be easily achieved by using 9' "' Tc-ECD and can accurately localize the epileptogenic zone in both temporal and extratemporal epilepsies. Ictal ECD SPECT proved to be significantly more sensitive and specific than interictal ECD SPECT, and clinically useful in the definition of the epileptogenic zone. Key Words: Epilepsy-Single photon emission computed tomography-Ethyl cysteinate dimer-Seizures-Epilepsy surgery.Functional neuroimaging techniques, including singlc photon emission computed tomography (SPECT), have an established role in the preoperative workup of patients with refractory epilepsy (1-3). Indeed, ictal SPECT with an already well-known agent, hexamethyl propyleneamine oxime (HMPAO), has proved to be one of the most sensitive techniques for the localization of ictal onset zones (4-8). Conversely, the interictal modality of SPECT, although easier to obtain, has lower sensitivity (ranging from 30 to 80%) and specificity (from 36 to 95%) for the localization of the epileptogenic zone (3, 9-1 5).

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Section: Discussionsupporting

confidence: 85%

Localization of the Epileptogenic Zone by Ictal and Interictal SPECT with ^99mTc‐Ethyl Cysteinate Dimer in Patients with Medically Refractory Epilepsy

Oliveira¹,

Costa²,

Hilario

et al. 1999

Epilepsia

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“…Single photon emission computed tomography (SPECT) (or PET) shows reduction in cerebral blood flow interictally but is less sensitive to medial temporal lobe epilepsy than PET measurement of metabolism, in the vicinity of S70% (61)(62)(63). SPECT measurement of ictal blood flow increases, however, is very sensitive, and is apt to be more circumscribed than interictal hypoperfusion or hypometabolism if the injection of radioligand is made early in the seizure (63)(64)(65)(66). It is of interest that these functional imaging studies usually have not demonstrated bilateral abnormalities in MTLE, despite MRI findings of bilateral hippocampal atrophy in -10-15% of patients, and bilateral pathologic and EEG findings in up to 80% of patients.…”

Section: Developmental Acquired Medial Temporal Lobe Epilepsy Localmentioning

confidence: 99%

Substrates of Localization‐Related Epilepsies: Biologic Implications of Localizing Findings in Humans

Spencer

1998

Epilepsia

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“…Interictal, ictal, and postictal patterns of regional cerebral blood flow (rCBF) are well described (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Patterns of rCBF in extratemporal seizures characterized in recent publications (15)(16)(17)(18)(19)(20)(21) suggest that regional cerebral perfusion (rCP) patterns in extratemporal seizures differ from those that occur during mesial temporal lobe seizures.…”

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confidence: 99%

Ictal Single Photon Emission Computed Tomography in Occipital Lobe Seizures

et al. 1997

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Summary:Purpose: Ictal single photon emission computed tomography (SPECT) has been evaluated as an adjunctive localizing technique in temporal lobe epilepsies and, to a lesser degree, in some extratemporal epilepsies. The purpose of this study was to determine whether occipital lobe seizures are associated with distinctive ictal cerebral blood perfusion (rCP) patterns.Methods: SPECT was used with the tracer 99mTc HMPAO to image ictal rCP in 6 patients in whom clinical, EEG, and imaging data indicated occipital lobe seizures.Results: Two patterns of rCP were seen. Four patients had hyperperfusion that was restricted to the occipital lobe, and two patients had hyperperfusion of the occipital lobe and the ipsilateral mesial temporal lobe, with hypoperfusion of the lateral temporal lobe. The latter 2 patients had clinical and surface EEG evidence of temporal lobe involvement in the seizure discharge. Conclusions:Ictal rCP patterns in occipital lobe seizures are distinct from those in temporal lobe seizures and may vary according to whether or not ipsilateral temporal lobe structures are involved in the ictal discharge. Key Words: Ictal-Single photon emission computed tomography-Occipital-Seizures-Regional cerebral perfusion.Single photon emission computed tomography (SPECT) with hexamethyl propylene amine oxime (HMPAO) has been used as an adjunctive localizing technique in mesial temporal lobe epilepsies (MTLE). Interictal, ictal, and postictal patterns of regional cerebral blood flow (rCBF) are well described (1-14). Patterns of rCBF in extratemporal seizures characterized in recent publications (15-21) suggest that regional cerebral perfusion (rCP) patterns in extratemporal seizures differ from those that occur during mesial temporal lobe seizures.Simple and complex partial seizures (SPS, CPS) may originate in the occipital lobe. They are characterized clinically by visual auras that may be followed by disturbance of consciousness, motionless stare, manual automatisms, and other manifestations of propagation of the seizure discharge into the temporal lobe (22-24). We report the results of ictal SPECT in six patients with clinical seizure semiology suggestive of occipital lobe origin, and lateralized occipital ictal EEG discharges.

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Regional cerebral blood flow during focal seizures of temporal and frontocentral onset

Cited by 120 publications

References 9 publications

Localization of the Epileptogenic Zone by Ictal and Interictal SPECT with ^99mTc‐Ethyl Cysteinate Dimer in Patients with Medically Refractory Epilepsy

Localization of the Epileptogenic Zone by Ictal and Interictal SPECT with ^99mTc‐Ethyl Cysteinate Dimer in Patients with Medically Refractory Epilepsy

Substrates of Localization‐Related Epilepsies: Biologic Implications of Localizing Findings in Humans

Ictal Single Photon Emission Computed Tomography in Occipital Lobe Seizures

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Regional cerebral blood flow during focal seizures of temporal and frontocentral onset

Cited by 120 publications

References 9 publications

Localization of the Epileptogenic Zone by Ictal and Interictal SPECT with 99mTc‐Ethyl Cysteinate Dimer in Patients with Medically Refractory Epilepsy

Localization of the Epileptogenic Zone by Ictal and Interictal SPECT with 99mTc‐Ethyl Cysteinate Dimer in Patients with Medically Refractory Epilepsy

Substrates of Localization‐Related Epilepsies: Biologic Implications of Localizing Findings in Humans

Ictal Single Photon Emission Computed Tomography in Occipital Lobe Seizures

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Localization of the Epileptogenic Zone by Ictal and Interictal SPECT with ^99mTc‐Ethyl Cysteinate Dimer in Patients with Medically Refractory Epilepsy

Localization of the Epileptogenic Zone by Ictal and Interictal SPECT with ^99mTc‐Ethyl Cysteinate Dimer in Patients with Medically Refractory Epilepsy