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Sequential 123I-iododexetimide scans in temporal lobe epilepsy: comparison with neuroimaging scans (MR imaging and 18F-FDG PET imaging)

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Muscarinic acetylcholine receptors (mAChRs) play an important role in the generation of seizures. Single-photon emission computed tomography (SPECT) with 123I-iododexetimide (IDEX) depicts tracer uptake by mAChRs. Our aims were to: (a) determine the optimum time for interictal IDEX SPECT imaging; (b) determine the accuracy of IDEX scans in the localisation of seizure foci when compared with video EEG and MR imaging in patients with temporal lobe epilepsy (TLE); (c) characterise the distribution of IDEX binding in the temporal lobes and (d) compare IDEX SPECT and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in identifying seizure foci.

Methods

We performed sequential scans using IDEX SPECT imaging at 0, 3, 6 and 24 h in 12 consecutive patients with refractory TLE undergoing assessment for epilepsy surgery. Visual and region of interest analyses of the mesial, lateral and polar regions of the temporal lobes were used to compare IDEX SPECT, FDG PET and MR imaging in seizure onset localisation.

Results

The 6-h IDEX scan (92%; κ=0.83, p=0.003) was superior to the 0-h (36%; κ=0.01, p>0.05), 3-h (55%; κ=0.13, p>0.05) and 24-h IDEX scans in identifying the temporal lobe of seizure origin. The 6-h IDEX scan correctly predicted the temporal lobe of seizure origin in two patients who required intracranial EEG recordings to define the seizure onset. Reduced ligand binding was most marked at the temporal pole and mesial temporal structures. IDEX SPECT was superior to interictal FDG PET (75%; κ=0.66, p=0.023) in seizure onset localisation. MR imaging was non-localising in two patients in whom it was normal and in another patient in whom there was bilateral symmetrical hippocampal atrophy.

Conclusion

The 6-h IDEX SPECT scan is a viable alternative to FDG PET imaging in seizure onset localisation in TLE.

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Authors and Affiliations

  1. Department of PET and Nuclear Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia

    Armin Mohamed, Stefan Eberl, Michael J. Fulham, Michael Kassiou, David Henderson, Scott Beveridge & Chris Constable

  2. Comprehensive Epilepsy Service, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia

    Armin Mohamed

  3. Faculty of Medicine, University of Sydney, Sydney, NSW, Australia

    Armin Mohamed, Michael J. Fulham & Aysha Zaman

  4. Department of Pharmacology, University of Sydney, Sydney, NSW, Australia

    Michael Kassiou

  5. Institute of International Health, University of Sydney, Sydney, NSW, Australia

    Sing Kai Lo

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  1. Armin Mohamed
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  2. Stefan Eberl
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  9. Sing Kai Lo
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Correspondence to Armin Mohamed.

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Mohamed, A., Eberl, S., Fulham, M.J. et al. Sequential 123I-iododexetimide scans in temporal lobe epilepsy: comparison with neuroimaging scans (MR imaging and 18F-FDG PET imaging). Eur J Nucl Med Mol Imaging 32, 180–185 (2005). https://doi.org/10.1007/s00259-004-1654-2

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  • DOI: https://doi.org/10.1007/s00259-004-1654-2

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