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Technetium-99m-HMPAO SPECT in partial status epilepticus
W O Tatum1, A Alavi, M M Stecker
1Department of Neurology, Graduate Hospital, Philadelphia, Pennsylvania.
Summary
Technetium Tc-99m HMPAO SPECT scans can indicate ongoing or recently ceased partial status epilepticus by showing focal hyperperfusion. A normal SPECT scan helps rule out this neurological condition.
Area of Science:
- Neurology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Status epilepticus is a neurological emergency requiring prompt diagnosis.
- Electroencephalography (EEG) and neuroimaging play crucial roles in evaluation.
- The utility of brain single-photon emission computed tomography (SPECT) in diagnosing status epilepticus needs further clarification.
Purpose of the Study:
- To correlate 99mTc-HMPAO brain SPECT findings with clinical and EEG data.
- To determine the diagnostic value of SPECT in patients with suspected status epilepticus.
Main Methods:
- Thirteen patients with suspected status epilepticus underwent serial neurological examinations, EEGs, CT/MRI, and 99mTc-HMPAO SPECT.
- Patients were categorized into status epilepticus (n=7) and other neurological diagnoses (n=6).
Main Results:
- All patients with active status epilepticus showed focal hyperperfusion on SPECT, consistent with EEG findings.
- One patient had persistent hyperperfusion 24 hours post-seizure without blood-brain barrier breakdown.
- No patients without status epilepticus exhibited focal hyperperfusion on SPECT.
Conclusions:
- 99mTc-HMPAO SPECT showing focal hyperperfusion is nonspecific for partial status epilepticus.
- It can indicate ongoing or recently terminated status epilepticus, even without blood-brain barrier disruption.
- A normal SPECT scan (no focal hyperperfusion) argues against the diagnosis of partial status epilepticus.