Journal of Korean Epilepsy Society  1999;3(2):180-185

Usefulness of ICTAL (99m)TC-ECD Brain SPECT for Pre-Surgical Evaluation in Temporal Lobe Epilepsy.

Joong Koo KANG 1 ; Sang Ahm LEE ; Hyeo Il MA ; Jin Sook RYU ; Do Young KANG ; Jung Kyo LEE

Affiliations

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Keywords

Temporal lobe Epilepsy; lctal SPECT; (Tc-99m)ECD; Semiology; Thalamic hyperperfusion; Brainstem hyperperfusion

Country

Republic of Korea

Language

Korean

Abstract

PURPOSE: We evaluated usefulness of ictal (99m)Tc-ECD SPECT in temporal lobe epilepsy (TLE) patients for per-surfical evaluation and also correlated ictal SPECT patterns with the semiology of seizures. We also investifated whether there are any differences in ictal SPECT pattern between temporal lobe seizures with or without secondary generalized tonic-clonic seizure (GTC). METHODS: ictal SPECT was performed in 26 TLE patients who had unlateral hippocampal atrophy (20 patients), other focal remporal lesions (4 patients), and normal MRI finding (2 patients). All patients underwent temporal lobectomy with a minimim 27 months follow-up with excellent post-surgical seizure outcome (Engel's classification class I). During CCTV monitoring (99m)Tc-ECD was injected during ictal peroid in all patients with a mean delay of 37.5+/-13.3 sec after seizure onset (mean seizure duration : 99.3+/-38.0 sec). Ictal SPECT was visually analysed by two blinded observers. RESULTS: Ictal (99m)Tc-ECD SPECT showed unilateral temporal hyperperfusion concordant with epileptogenic foci in 25/26 (96.2%). The hyperperfusion of the ipsilateral basal ganglia was evident in 12/19 (63.2%) during contralateral (or predominantly contralateral) hand dystonic/ tonic posture. The contralateral cerebellar hyperperfusion was observed in the 6/26 (23.1%). Seizures with secondary GTC at the time of injection showed brainstem and bilateral thalamic hyperperfusion in 6/8 (75.0%) and seizures without secondary GTC at the time of injection showed brainstem and bilateral thalamic hyperperfusion in 2/18 (11.1%). There was significant difference between two groups (p<0.01). CONCLUSION: L Ictal (99m)Tc-ECD SPECT is a useful method to localize the epileptic foci for pre-surfical evaluation and the hyperperfusion of bilateral thalamus and brainstem is significantly frequent during secondary generalization of temporal lobe seizure.