Abstracts

Rationale: Cerebral perfusion Spect imaging (SPECT) and other neuroimaging techniques have been used in the differential diagnosis of epileptic and psychogenic seizures and also in the differentiation between nonconvulsive status epilepticus (NCSE) and different forms of encephalopathy although the information about it diagnostic value in these situations is still scare. Our purpose is to present the utility of different neuroimage techniques (structural and functional) in the diagnostic of NCSE when the EEG is no clear. Methods: Eight patients with clinical suspicion of a NCSE and a non diagnostic video-EEG (normal or with periodic pattern) were included. Periodic lateralized epileptiform discharges (PLEDS) or generalized epileptiform discharges (GPEDs) were the most frequent periodic pattern. Ictal Spect or angioTC or MRI were done in these patients. Results: In five patients an ictal Spect was done, in two and MRI and in 1 an angioTC. In three patients (2 ictal Spect,1 angioTC) a focal hyperperfusion were observed, in three (ictal Spect) a generalized patchy hypoperfusion and in the restant two focal cortical oedema or hemispheric cortical laminar necrosis (on MRI studies). Five patients were diagnosed and treated as NCSE and three patients were diagnosed and treated as encephalopathy. Interictal neuroimage techniques were done in four of the five patients diagnosed of NCSE and cortical perfusion normalization were observed in all of them. Conclusions: 1. Spect and other neuroimaging techniques maybe useful in diagnosing NCSE when video-EEG is unconclusive. 2. Association of PLEDS and focal hyperperfusion on SPECT, confirm PLEDs as an ictal pattern in patients with suspicion of NCSE.