Related Experiment Videos
Ictal SPECT in nonlesional extratemporal epilepsy
Gregory D Cascino1, Jeffrey R Buchhalter, Brian P Mullan
1Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA. gcascino@mayo.edu
Epilepsia
|July 30, 2004
Summary
Subtraction periictal SPECT coregistered to MRI (SISCOM) identified the seizure focus in a patient with difficult-to-treat epilepsy. This imaging technique guided successful surgical intervention, leading to seizure freedom.
Area of Science:
- Neurology
- Neurosurgery
- Medical Imaging
Background:
- Intractable partial epilepsy often requires surgical intervention to localize the epileptogenic zone.
- Nonlesional extratemporal epilepsy presents diagnostic challenges for precise localization.
- Ictal SPECT imaging is a potential tool for identifying the seizure onset zone.
Observation:
- A patient with intractable partial epilepsy and unclear seizure localization underwent advanced imaging.
- Ictal semiology suggested a "hypermotor" seizure, but MRI and electroclinical correlation were inconclusive.
- Subtraction periictal SPECT coregistered to MRI (SISCOM) was employed for presurgical evaluation.
Findings:
- SISCOM revealed localized hyperperfusion in the right supplementary sensorimotor area.
- Intracranial EEG monitoring confirmed SISCOM findings, correlating with the ictal onset zone.
- The patient achieved seizure freedom following surgical resection guided by SISCOM.
Implications:
- SISCOM can be valuable in identifying surgical candidates for nonlesional extratemporal epilepsy.
- Periictal imaging may refine presurgical planning, including intracranial EEG strategies and focal cortical resection.
- This case highlights the utility of advanced SPECT techniques in epilepsy surgery.