Document Detail

The usefulness of repeated ictal SPET for the localization of epileptogenic zones in intractable epilepsy.
MedLine Citation:
PMID:  11976798     Owner:  NLM     Status:  MEDLINE    
This study investigated whether repeated ictal single-photon emission tomography (SPET) is helpful in the localization of epileptogenic zones and whether it can provide information confirming that an area of increased perfusion is really the culprit epileptogenic lesion. Fifty-four repeated ictal SPET studies were performed in 24 patients with ambiguous or unexpected findings on the first ictal SPET study. These patients were enrolled from among 502 patients with intractable epilepsy in whom pre-operative localization of epileptogenic zones was attempted with a view to possible surgical resection. Video monitoring of ictal behaviour and EEGs was performed in all patients. Repeated ictal SPET was performed using technetium-99m hexamethylpropylene amine oxime (HMPAO) when there was no prominently hyperperfused area or when unexpected findings were obtained during the first study. Two ictal SPET studies were performed in 19 patients, three studies in four patients and four studies in one patient. The average delay between ictal onset and injection was 28 s for the first study and 22 s for the second, third and fourth studies. Using interictal SPET, ictal-interictal subtraction images were acquired and co-registered with the population magnetic resonance imaging (MRI) template. Invasive study and surgery were performed in 18 patients, and in these cases the surgical outcome was known. In the other six patients, epileptogenic foci were determined using MRI, positron emission tomography (PET) and ictal EEG findings. Two patients were found to have mesial temporal lobe epilepsy, two lateral temporal lobe epilepsy, eight frontal lobe epilepsy, three parietal lobe epilepsy and one occipital lobe epilepsy. The other eight had multifocal epilepsy. The first study was normal in 12 patients (group I) and indicated certain zones to be epileptogenic in the other 12 (group II). Among group I, the correct epileptogenic zone or lateralization was revealed at the repeated study in nine patients, while in the other three it was not. Among group II, six patients showed the same results at the second study, thus confirming that the initially identified zones were of epileptogenic significance. In the other six patients, different areas were identified on the first and second studies, and repeated ictal SPET corroborated multifocality of the ictal EEG findings in five. These results indicate that repeated ictal SPET is useful because it can yield new or additional information about the epileptogenic zones and can confirm that a region of interest is an epileptogenic zone or that the epilepsy is of multifocal origin.
Dong Soo Lee; Sang Kun Lee; Yu Kyeong Kim; Eunjoo Kang; Jae Sung Lee; June-Key Chung; Myung Chul Lee
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2002-03-06
Journal Detail:
Title:  European journal of nuclear medicine and molecular imaging     Volume:  29     ISSN:  1619-7070     ISO Abbreviation:  Eur. J. Nucl. Med. Mol. Imaging     Publication Date:  2002 May 
Date Detail:
Created Date:  2002-04-26     Completed Date:  2002-11-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  101140988     Medline TA:  Eur J Nucl Med Mol Imaging     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  607-14     Citation Subset:  IM    
Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yungundong, Chongnogu, Seoul 110-744, Korea.
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MeSH Terms
Brain / blood supply*,  radionuclide imaging*
Cerebrovascular Circulation
Child, Preschool
Epilepsies, Partial / radionuclide imaging*
Follow-Up Studies
Magnetic Resonance Imaging / methods
Radiopharmaceuticals / diagnostic use
Reproducibility of Results
Sensitivity and Specificity
Single-Blind Method
Subtraction Technique
Technetium Tc 99m Exametazime / diagnostic use*
Tomography, Emission-Computed, Single-Photon / methods*
Reg. No./Substance:
0/Radiopharmaceuticals; 100504-35-6/Technetium Tc 99m Exametazime

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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