Ictal SPECT as a Predictor of the Epileptogenic Region
Abstract number :
1.223
Submission category :
Year :
2001
Submission ID :
362
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
D. Eliashiv, MD, Neurology, Cedars Sinai/UCLA, Los Angeles, CA; P. Mullin, MD, Neurology, Cedars Sinai/UCLA, Los Angeles, CA; S. Elsas, MD, Neurology, Cedars-Sinai/UCLA School of Medicine, Los Angeles, CA; A. D`Agnolo, MD, Nuclear Medicine, Cedars Sinai M
RATIONALE: The objective of this study was to evaluate the role of Ictal SPECT as a localizing tool in patients with medically refractory partial epilepsy that are insufficiently localized and still considered candidates for resective epilepsy surgery.
METHODS: Ictal SPECT was obtained in 100 patients. Invasive electrode and/or postsurgical outcome confirmation was obtained in 50 patients. Patients were injected within 3o seconds of ictal onset with 20 mci of Tc99M or stabilized HMPOA. The injection delay was verified by concurrent video/EEG recordings. All patients underwent an interictal SPECT study. The ictal and interictal studies were substracted in the last 30 patients.Images were acquired utilizing a triple detector camera with axial, coronal and sagittal cuts obtained.The regions of increased uptake were identified with the reader blinded to the clinical information.
RESULTS: Co-localization of the Ictal SPECT defined epileptogenic region as compared to post resection outcome and/or invasive electrode recordings were found in 35/50 patients. False localization occured in patients with multifocal onsets, structural lesions and rapid secondary propagation to mesiotemporal lobe structures.
CONCLUSIONS: Ictal SPECT provides succsefully localizes patients with insufficiently localized partial epilepsy that are candidates for resective epilepsy surgery. However,recognition of subsets of patients with false localization is important.
Support: N/A