Abstracts

RATIONALE:_Ictal SPECT is a valuable tool in the pre-surgical evaluation of refractory extratemporal lobe epilepsy. The timing of injection is a critical factor in accurately localizing the epileptogenic zone. However, significant practical difficulties are associated with obtaining early ictal injections in this subgroup of patients as the seizures are typically brief and often associated with hypermotor activity. Early injections are facilitated if an epilepsy specialist remains at the bedside until a patient has a seizure. Unfortunately, given the variability of seizures and the limited hours during which injections can be performed, considerable time and effort may be involved in obtaining an ictal SPECT. METHODS: We prospectively evaluated the role of an epilepsy nurse practitioner trained in seizure recognition in administering ictal HMPAO SPECT injections. All patients had refractory extratemporal lobe epilepsy. For each injection the nurse practitioner stayed in the room and injected as early as possible after seizure onset. The timing of injection was compared to a cohort of patients injected by a physician. We also qualitatively analyzed radiation safety issues that may be improved by having one person performing the injections. RESULTS: Sixteen patients received an ictal injection performed by the epilepsy nurse practitioner. The median time to injection was 9.5 seconds, mean 15 seconds(range 3-47 seconds). Of 60 similar patients with extratemporal lobe seizures injected by a physician the median and mean times were 10 and 15 seconds respectively. The mean time spent in the patient's room before obtaining an ictal injection was 8.3 hours, over, on average, 2 consecutive days. No significant adverse events occurred. No patients were injected inappropriately and no post-ictal injections occurred. CONCLUSIONS: A nurse practitioner trained in seizure recognition and radiation safety may be utilized to administer ictal SPECT injections. The timing, safety and appropriateness of injection are all similar to that obtained by an epileptologist. While considerable time input is involved, this may be utilized in education and counseling of the patient and family members.