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Single photon emission computed tomography-EEG relations in temporal lobe epilepsy

 Lee BI  ;  Lee JD  ;  Kim JY  ;  Ryu YH  ;  Kim WJ  ;  Lee JH  ;  Lee SJ  ;  Park SC 
 NEUROLOGY, Vol.49(4) : 981-991, 1997 
Journal Title
Issue Date
Adolescent ; Adult ; Cysteine/analogs & derivatives ; Electroencephalography* ; Epilepsy, Temporal Lobe/diagnosis* ; Epilepsy, Temporal Lobe/physiopathology ; Epilepsy, Temporal Lobe/surgery ; Female ; Functional Laterality ; Humans ; Male ; Organotechnetium Compounds ; Radiopharmaceuticals ; Retrospective Studies ; Technetium Tc 99m Exametazime ; Temporal Lobe/surgery ; Tomography, Emission-Computed, Single-Photon*
The role of single photon emission computed tomography (SPECT) as an independent confirmation test in presurgical evaluation of medically intractable temporal lobe epilepsy has not been critically investigated. Because spreading ictal discharges may cause a concomitant increase of cerebral blood flow in remote cerebral regions, a careful analysis of peri-injection EEG patterns and their relation to ictal SPECT may be important in evaluating the reliability of ictal SPECT. Both interictal and ictal EEG and SPECT were reviewed in 19 patients with temporal lobe epilepsy who achieved a successful seizure outcome after surgery. Patients were divided into unitemporal and bitemporal groups according to the lateralization of interictal epileptiform discharges (IED). Ictal EEG features were classified into lateralized and nonlateralized groups. The concordance between SPECT and EEG lateralizations was examined in each patient and correlated to the documented epileptogenic temporal lobe. Interictal SPECT correctly lateralized in eight of nine patients with unitemporal IED and in five of 10 patients with bitemporal IED. Ictal SPECT was highly concordant with the peri-injection ictal EEG but correctly lateralized the epileptogenic region in only 11 of 19 patients. When both pre- and postinjection EEG epochs lateralized ipsilaterally, all ictal SPECT images showed concordant lateralization. If pre- and postinjection EEG epochs were either different in lateralization or nonlateralization, ictal SPECT images often showed complex patterns of cerebral perfusion with a high incidence of false lateralization. Interictal SPECT was more sensitive and reliable in patients with unitemporal IED than in patients with bitemporal IEDs. Ictal SPECT was closely related with peri-injection EEG epochs but with frequent false lateralization. The role of ictal SPECT as an independent confirmation test in presurgical evaluation should be reappraised.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Won Joo(김원주) ORCID logo https://orcid.org/0000-0002-5850-010X
Park, Soo Chul(박수철)
Ryu, Young Hoon(유영훈) ORCID logo https://orcid.org/0000-0002-9000-5563
Lee, Jong Doo(이종두)
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