Ictal Single Photon Emission Computed Tomography (SPECT) in Patients with Focal Aware Seizure Without Ictal Electroencephalographic Changes: A Single Center Experience
Abstract number :
3.255
Submission category :
5. Neuro Imaging / 5B. Functional Imaging
Year :
2022
Submission ID :
2204871
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Saniya Pervin, MD – University of Kentucky; Riham El Khouli, MD, PhD – University of Kentucky; Jordan Clay, MD – University of Kentucky; Sally Mathias, MD – University of Kentucky
Rationale: There are currently limited literature on the localization value of ictal SPECT tracer injection during patient-reported typical focal aware seizures (auras) that lack electrographic changes. One study reported that ictal SPECT studies in isolated auras lack reliability, with concordant and correct localization with the seizure onset zone (SOZ) obtained in 5%, and lateralization in 35% of cases [1]. In another study, localizing information of self-injection of subtraction ictal SPECT was better in three patients and obviated the need for intracranial monitoring in one patient [2]. We present a study in which tracer injection was administered for patient-reported typical focal aware seizures, where the subsequent analysis of ictal and interictal SPECT helped inform further management. _x000D_
Methods: We performed a retrospective review of cases who underwent ictal SPECT between July 2020 and June 2022 at the University of Kentucky hospital. Cases with radiotracer injection during patient-reported auras lacking electrographic changes were identified. Timing of injection from the onset of reported aura, hyper-perfusion changes on ictal SPECT, and the outcome of imaging on further management of refractory epilepsy was noted.
Results: A total of 20 patients underwent ictal SPECT, of which 7 met our inclusion criteria. None of the 7 cases had electrographic correlate with aura on scalp EEG. Time of tracer injection ranged from 1 to 17 seconds following the onset of aura. Locations of focal hyper-perfusion regions are reported in Table 1.
Conclusions: Ictal SPECT with radiotracer injection during typical focal aware seizures (patient-reported auras) without ictal electrographic changes is helpful in the localization of the seizure onset zone. Additional, similar studies with larger sample size and outcome information are needed to assess the accuracy of localization.
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References:_x000D_
1. Elwan SA, Wu G, Huang SS, Najm IM, So NK. Ictal single photon emission computed tomography in epileptic auras. Epilepsia. 2014;55(1):133-136._x000D_
2. Van Paesschen W, Dupont P, Van Heerden B, Vanbilloen H, Mesotten L, Maes A, Van Driel G, Mortelmans L. Self-injection ictal SPECT during partial seizures. Neurology. 2000 May 23;54(10):1994-1997.
Funding: None
Neuro Imaging