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Published on: November 19, 2020
Cerebral perfusion changes in mesial temporal lobe epilepsy: SPM analysis of ictal and interictal SPECT
Woo Suk Tae1, Eun Yeon Joo, Jee Hyun Kim
1Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710, Republic of Korea.
Abstract:
We examined cerebral perfusion changes in mesial temporal lobe epilepsy (mTLE) by the statistical parametric mapping of brain single photon emission computed tomography (SPECT) images of 38 mTLE patients and 19 normal controls. Ictal and interictal SPECTs were compared with control SPECTs by independent t test, and ictal and interictal SPECTs by paired t test. We evaluated the number of heterotopic neurons in temporal lobe white matter, white matter changes of the anterior temporal lobe (WCAT) and ictal hyperperfusion of the temporal stem (IHTS). Left mTLE showed interictal hypoperfusion in the ipsilateral hippocampus, bilateral thalami, and paracentral lobules. Right mTLE showed hypoperfusion in bilateral hippocampi, contralateral insula, bilateral thalami, and paracentral lobules. Both mTLEs showed ictal hyperperfusion in bilateral temporal lobes with ipsilateral predominance, and in the anterior frontal white matter bilaterally. By paired t test, ictal hyperperfusion was found in the ipsilateral temporal lobe, temporal stem, hippocampus, thalamus, putamen, insula, and bilateral precentral gyri, whereas ictal hypoperfusion was found in bilateral frontal poles and middle frontal gyri. Fifteen patients showed WCAT and 19 showed IHTS, a weak correlation was observed between WCAT and IHTS (r = 0.377, P = 0.02). WCAT was found to correlate with an early seizure onset age. In 35 patients, heterotopic neurons were found in the white matter of the resected temporal lobe, but the number of heterotopic neurons did not correlate with WCAT or IHTS. In summary, the cerebral perfusion patterns of mTLE suggest interictal hypofunction and ictal activation of the cortico-thalamo-hippocampal-insular network and ictal hypoperfusion of the anterior frontal cortex.
Insights
Mesial temporal lobe epilepsy (mTLE) shows reduced brain perfusion between seizures and increased activity during seizures, particularly in the cortico-thalamo-hippocampal-insular network. White matter changes correlate with early seizure onset.
Area of Science:
- Neuroscience
- Epileptology
- Medical Imaging
Background:
- Mesial temporal lobe epilepsy (mTLE) is a common epilepsy syndrome.
- Understanding cerebral perfusion changes in mTLE is crucial for diagnosis and treatment.
- Previous studies have investigated perfusion abnormalities, but a comprehensive analysis is needed.
Purpose of the Study:
- To investigate cerebral perfusion changes in patients with mTLE using single photon emission computed tomography (SPECT).
- To correlate perfusion patterns with white matter changes and heterotopic neurons.
- To elucidate the functional network involved in mTLE.
Main Methods:
- Statistical parametric mapping of brain SPECT images from 38 mTLE patients and 19 controls.
- Comparison of ictal and interictal SPECTs with control SPECTs using independent and paired t-tests.
- Evaluation of white matter changes (WCAT) and ictal hyperperfusion (IHTS).
Main Results:
- Interictal hypoperfusion observed in the hippocampus, thalami, and paracentral lobules, with lateralization differences.
- Ictal hyperperfusion in temporal lobes, temporal stem, hippocampus, thalamus, insula, and frontal white matter.
- Weak correlation between WCAT and IHTS; WCAT correlated with early seizure onset.
Conclusions:
- Cerebral perfusion patterns in mTLE suggest interictal hypofunction and ictal activation of the cortico-thalamo-hippocampal-insular network.
- Ictal hypoperfusion in the anterior frontal cortex was also noted.
- WCAT and IHTS may serve as biomarkers, with WCAT linked to earlier disease onset.
