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Ictal and interictal ECD-SPECT for focus localization in epilepsy
U Runge1, G Kirsch, B Petersen
1Department of Neurology, Ernst-Moritz-Arndt-University of Greifswald, Germany.
Acta Neurologica Scandinavica
|December 24, 1997
Summary
Technetium-99m-ethyl cysteinate dimer (ECD) SPECT effectively identifies the epileptogenic zone in epilepsy surgery candidates. Ictal SPECT demonstrates hyperperfusion, aiding in precise localization of the seizure focus.
Area of Science:
- Neurology
- Nuclear Medicine
- Epileptology
Background:
- Pharmacoresistant focal epilepsy requires precise localization of the epileptogenic zone for surgical treatment.
- Presurgical diagnostic work-up aims to identify the brain region responsible for seizures.
Purpose of the Study:
- To evaluate the effectiveness of Technetium-99m-ethyl cysteinate dimer (ECD) SPECT in localizing the epileptogenic focus in patients with pharmacoresistant focal epilepsy.
- To compare ictal and interictal SPECT findings with electrophysiological data.
Main Methods:
- Forty-one ECD SPECT investigations were performed in 23 epilepsy patients.
- 21 patients underwent both ictal and interictal SPECT scans.
- Tracer injection for ictal SPECT occurred 7-30 seconds post-seizure onset.
Main Results:
- Interictal SPECT showed focal hypoperfusion in 17 of 23 patients (74%), correlating with the electrophysiological focus.
- Ictal SPECT revealed regional hyperperfusion in 18 of 21 patients (86%), accurately locating the epileptogenic zone.
- Three patients with short seizures showed postictal hypoperfusion on ictal SPECT.
Conclusions:
- Ictal ECD-SPECT is a valuable tool for demonstrating the epileptogenic focus in presurgical epilepsy evaluation.
- Accurate timing of tracer injection is crucial for ictal SPECT interpretation.
- ECD-SPECT aids in identifying surgical targets for intractable focal epilepsy.