Evaluating the development of a SPECT protocol in a Canadian epilepsy unit

Area of Science:

• Epilepsy research
• Neuroimaging techniques
• Nuclear medicine

Background:

• Functional neuroimaging aids seizure localization, potentially reducing the need for invasive intracranial EEG.
• Ictal Single Photon Emission Computed Tomography (SPECT) is crucial for presurgical evaluation in medically-intractable epilepsy.

Purpose of the Study:

• To assess if a nurse-led ictal injection program enhances radiopharmaceutical delivery efficiency.
• To determine if this program improves the sensitivity and specificity of ictal SPECT outcomes.

Main Methods:

• Nursing staff administer 99mTc-HMPAO at the patient's bedside during or at seizure onset.
• Brain SPECT imaging is conducted later using a gamma camera.

Main Results:

• A total of 57 scans (22 ictal, 35 interictal) were performed post-protocol implementation.
• Mean ictal injection latency was 19.7 seconds; 80% of radiopharmaceutical vials were utilized.
• Sixty-three percent of SPECT studies aligned with standard presurgical evaluations.

Conclusions:

• The protocol demonstrates efficiency, with low injection latency and high radiopharmaceutical utilization.
• Nurse-led ictal SPECT is a safe, noninvasive, and routine procedure in epilepsy units.
• Structured multidisciplinary programs incorporating trained support staff are key to successful implementation.