Pontine hyperperfusion associated with ictal central apnea.

Area of Science:

• Neurology
• Epileptology
• Neuroimaging

Background:

• Focal epilepsy can present with complex seizure semiologies.
• Ictal central apnea (ICA) is a rare but serious complication of focal seizures.
• Identifying the ictal onset zone is crucial for epilepsy surgery.

Purpose of the Study:

• To report ictal SPECT findings in a patient with focal epilepsy and ICA.
• To investigate the utility of ictal SPECT in localizing seizure onset in the presence of ICA.
• To highlight potential imaging markers for ICA and associated risks.

Main Methods:

• Case report of a 38-year-old female with left posterior quadrant epilepsy and ICA.
• Continuous EEG monitoring and ictal SPECT during a typical seizure with ICA.
• Tracer administration timed relative to ICA onset, EEG onset, and clinical changes.
• Analysis of SPECT findings for hyperperfusion patterns.

Main Results:

• Ictal SPECT demonstrated significant hyperperfusion in the anterior pons.
• Mild left > right lateralization of hyperperfusion was observed.
• The SPECT findings correlated with seizure onset and ICA development.

Conclusions:

• Ictal SPECT can highlight brain regions associated with ICA in focal epilepsy.
• Pontine hyperperfusion on ictal SPECT may be an imaging marker for ICA.
• Increased vigilance for pontine hyperperfusion is recommended due to the risk of sudden unexpected death in epilepsy (SUDEP).