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Validation of ictal single photon emission computed tomography with depth encephalography and epilepsy surgery

Neurosurgical Review volume 27, pages 27–33 (2004)Cite this article

Abstract

Many centers have reported that ictal single photon emission computed tomography (SPECT) localizes regions of seizure onset with greater sensitivity and specificity than interictal SPECT. Here we report interictal and ictal SPECT scan results in both lesional and nonlesional cases. Using technetium hexamethyl propylamenamine oxide (HMPAO) or ethyl cysteinate dimer (ECD), these scans were done in 52 patients with partial and secondarily generalized seizures. Twenty-five had normal MRI and 27 showed structural lesions. None had mesial temporal sclerosis clearly identified on MRI. All 52 subsequently had interictal and ictal intracranial EEG studies that appeared to localize the seizure focus. Thirty-nine patients had surgery and have been followed for 2 or more years. Interictal SPECT scans showed focal hypoperfusion consistent with intracranial EEG localization of the seizure focus in 29% of patients. In another 13%, there was correct lateralization but not localization. Ictal SPECT scans showed focal hyperperfusion consistent with intracranial EEG localization of the seizure focus in 52% of patients. In another 25%, there was correct lateralization but not localization. The presence or absence of structural lesions on MRI did not affect ictal hyperperfusion or its correlation with intracranial EEG. Thirty-nine patients had resective surgery, of whom 62% had class I outcomes. There was a trend towards better outcome when ictal SPECT data were concordant with intracranial EEG data. The presence or absence of structural lesions on MRI did not affect the likelihood of class I outcome. Ictal SPECT is superior to interictal SPECT in localizing and lateralizing seizure foci. Its results correlate well with intracranial EEG, but in more than one third of cases, the latter shows focal seizure onset in areas that do not show focal hyperperfusion. Surgical outcome tends to be better when the two modalities give concordant results.

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References

  1. Aihara M, Hatakeyama K, Koizumi K, Nakazawa S (1997) Ictal EEG and single photon emission computed tomography in a patient with cortical dysplasia presenting with atonic seizures. Epilepsia 38:723–727

    CAS  PubMed  Google Scholar 

  2. Awad AA, Rosenfeld J, Ahl J, Hahn JF, Lüders H (1991) Intractable epilepsy and structural lesions of the brain: mapping, resection strategies, and seizure outcome. Epilepsia 32:179–186

    CAS  PubMed  Google Scholar 

  3. Bautista RED, Cobbs MA, Spencer DD, Spencer SS (1999) Prediction of surgical outcome by interictal epileptiform abnormalities during intracranial EEG monitoring in patients with refractory seizures. Epilepsia 40:880–890

    CAS  PubMed  Google Scholar 

  4. Boon PA, Williamson PD, Fried I, Spencer DD, Novelly RA, Spencer SS, Matson RH (1991) Intracranial, intraaxial, space-occupying lesions in patients with intractable partial seizures: an anatomoclinical, neuropsychological, and surgical correlation. Epilepsia 32:467–476

    CAS  PubMed  Google Scholar 

  5. Cascino GD, Jack CR Jr, Sharbrough FW, Kelly PJ, Marsh WR (1993) MRI assessments of hippocampal pathology in extratemporal lesional epilepsy. Neurology 43:2380–2382

    CAS  PubMed  Google Scholar 

  6. Cendes F, Caramanos Z, Andermann F, Dubeau F, Arnold DL (1997) Proton magnetic resonance spectroscopic imaging and magnetic resonance imaging volumetry in the lateralization of temporal lobe epilepsy: a series of 100 patients. Ann Neurol 42:737–746

    CAS  PubMed  Google Scholar 

  7. Connelly A, Van Paesschen W, Porter DA, Johnson CL, Duncan JS, Gadian DG (1998) Proton magnetic resonance spectroscopy in MRI-negative temporal lobe epilepsy. Neurology 51:61–66

    CAS  PubMed  Google Scholar 

  8. Duncan R, Biraben A, Patterson J, Hadley D, Bernard AM, Lecloirec J, Vignal J-P, Chauvel P (1997) Ictal single photon emission computed tomography in occipital lobe seizures. Epilepsia 38:839–843

    CAS  PubMed  Google Scholar 

  9. Fitzpatrick JM, Hill DJ, Shy Y, West J, Studholme C, Maurer CR (1998) Visual assessment of the accuracy of retrospective registration of MRI and CT images of the brain. IEEE Trans Biomed Eng 17:571–586

    Article  CAS  Google Scholar 

  10. Harvey A, Hopkins IJ, Bowe JM, Cook DJ, Shield LK, Berkovic SF (1993) Frontal lobe epilepsy: clinical seizure characteristics and localization with ictal 99mTc-HMPAO SPECT. Neurology 43:1966–1980

    CAS  PubMed  Google Scholar 

  11. Ho SS, Berkovic SF, Newton MR, Austin MC, McKay WJ, Bladin PF (1994) Parietal lobe epilepsy: clinical features and seizure localization by ictal SPECT. Neurology 44:2277–2284

    CAS  PubMed  Google Scholar 

  12. Ho SS, Berkovic SF, McKay WJ, Kalnins RM, Bladin PF (1996) Temporal lobe epilepsy subtypes: differential patterns of cerebral perfusion on ictal SPECT. Epilepsia 37:788–795

    CAS  PubMed  Google Scholar 

  13. Ho SS, Kuzniecky RI, Gilliam F, Faught E, Morawetz R (1998) Temporal lobe developmental malformations and epilepsy: dual pathology and bilateral hippocampal abnormalities. Neurology 50:748–754

    CAS  PubMed  Google Scholar 

  14. Jack CR Jr, Mullan BP, Sharbrough FW, Cascino GD, Hauser MF, Krecke KN, Luetmer PH, Trenerry MR, O'Brien PC, Parisi JE (1994) Intractable nonlesional epilepsy of temporal lobe origin: lateralization by interictal SPECT versus MRI. Neurology 44:829–836

    PubMed  Google Scholar 

  15. Knowlton RC, Laxer KD, Ende G, Hawkins RA, Wong STC, Matson GB, Rowley HA, Fein G, Weiner MW (1997) Presurgical multimodality neuroimaging in electroencephalographic lateralized temporal lobe epilepsy. Ann Neurol 42:829–837

    Google Scholar 

  16. Lewis PJ, Siegel A, Siegel AM, Studholme C, Sojkova J, Roberts DW, Thadani VM, Gilbert KL, Darcey TM, Williamson PD (2000) Does performing image registration and subtraction in ictal brain SPECT help localize neocortical seizures? J Nucl Med 41:1619–1626

  17. Li LM, Cendes F, Watson C, Andermann F, Fish DR, Dubeau F, Free S, Olivier A, Harkness W et al (1997) Surgical treatment of patients with single and dual pathology: relevance of lesion and of hippocampal atrophy to seizure outcome. Neurology 48:437–444

    CAS  PubMed  Google Scholar 

  18. Marks DA, Katz A, Hoffer P, Spencer SS (1992) Localization of extratemporal epileptic foci during ictal single photon emission computed tomography. Ann Neurol 31:250–255

    CAS  PubMed  Google Scholar 

  19. Newton MR, Berkovic SF (1996) Interictal, ictal and post-ictal single-photon emission computed tomography. In: Cascino GD, Jack DR (eds) Neuroimaging in epilepsy. Butterworth-Heinemann, Boston, pp 177–191

  20. O'Brien TJ, So EL, Mullan BP, Hauser MF, Brinkmann BH, Bohnen NI, Hanson D, Cascino GD, Jack CR Jr, Sharbrough FW (1998) Subtraction ictal SPECT coregistered to MRI improves clinical usefulness of SPECT in localizing the surgical seizure focus. Neurology 50:445–454

    CAS  PubMed  Google Scholar 

  21. O'Brien TJ, So EL, Mullan BP, Cascino GD, Hauser MF, Brinkmann GH, Sharbrough FW, Meyer FB (2000) Subtraction peri-ictal SPECT is predictive of extratemporal epilepsy surgery outcome. Neurology 55:1668–1677

    CAS  PubMed  Google Scholar 

  22. Oliveira AJ, da Costa JC, Hilario LN, Anselmi OE, Palmini A (1999) Localization of the epileptogenic zone by ictal and interictal SPECT with99mTC-ethyl cysteinate dimer in patients with medically refractory epilepsy. Epilepsia 40:693–702

    CAS  PubMed  Google Scholar 

  23. Rassi-Neto A, Ferraz FP, Campos CR, Braga FM (1999) Patients with epileptic seizures and cerebral lesions who underwent lesionectomy restricted to or associated with the adjacent irritative area. Epilepsia 40:856–864

    CAS  PubMed  Google Scholar 

  24. Rowe CC, Berkovic SF, Sia STB, Austin M, McKay WJ, Kalnins RM, Bladin PF (1989) Localization of epileptic foci with postictal single photon emission computed tomography. Ann Neurol 26:660–668

    CAS  PubMed  Google Scholar 

  25. Sisodiya SM, Stevens JM, Fish DR, Free SL, Shorvon SD (1996) The demonstration of gyral abnormalities in patients with cryptogenic partial epilepsy using three-dimensional MRI. Arch Neurol 53:28–34

    CAS  PubMed  Google Scholar 

  26. Stanley JA, Cendes F, Dubeau F, Andermann F, Arnold DL (1998) Proton magnetic resonance spectroscopic imaging in patients with extratemporal epilepsy. Epilepsia 39:267–273

    CAS  PubMed  Google Scholar 

  27. Studholme C, Hill DJG, Hawkes DJ (1999) An overlap invariant entropy measure of 3D medical image alignment. Pattern Recognition 32:71–86

    Article  Google Scholar 

  28. Theodore WH, Sato S, Kufta CV, Gaillard WD, Kelley K (1997) FDG-positron emission tomography and invasive EEG: seizure focus detection and surgical outcome. Epilepsia 38:81–86

    CAS  PubMed  Google Scholar 

  29. Van Paesschen W, Revesz T, Duncan JS, King MD, Connelly A (1997) Quantitative neuropathology and quantitative magnetic resonance imaging of the hippocampus in temporal lobe epilepsy. Ann Neurol 42:756–766

    PubMed  Google Scholar 

  30. West J, Fitzpatrick JM, Wang MY, et al (1997) Comparison and evaluation of retrospective intermodality brain imaging registration techniques. J Comput Assist Tomogr 21:554–566

    Article  CAS  PubMed  Google Scholar 

  31. Wong JCH, Studholme C, Hawkes DJ, Maisey MN (1997) Evaluation of the limits of visual detection of image misregistration in a brain fluorine-18 fluorodeoxyglucose PET-MRI study. Eur J Nucl Med 24:642–650

    Google Scholar 

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Acknowledgements

A.M.S. was supported by the Schweizerischer Nationalfonds (Swiss National Research Foundation) and the Kommission zur Förderung des akademischen Nachwuchses des Kt. Zürichs (Commission for Promoting Academic Development of the Kanton of Zürich).

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Affiliations

  1. Section of Neurology, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA

    Vijay M. Thadani, Barbara C. Jobst, Karen L. Gilbert, Terrance M. Darcey, David W. Roberts & Peter D. Williamson

  2. Section of Diagnostic Radiology, Dartmouth Hitchcock Medical Center, Lebanon, N.H., USA

    Alan Siegel & Petra Lewis

  3. Department of Neurology, University Hospital, Zürich, Switzerland

    Adrian M. Siegel

  4. Thayer School of Engineering, Dartmouth College, Lebanon, N.H., USA

    Terrance M. Darcey

Authors
  1. Vijay M. Thadani
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  2. Alan Siegel
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  3. Petra Lewis
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  4. Adrian M. Siegel
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  5. Barbara C. Jobst
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  7. Terrance M. Darcey
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  8. David W. Roberts
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  9. Peter D. Williamson
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Correspondence to Vijay M. Thadani.

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Thadani, V.M., Siegel, A., Lewis, P. et al. Validation of ictal single photon emission computed tomography with depth encephalography and epilepsy surgery. Neurosurg Rev 27, 27–33 (2004). https://doi.org/10.1007/s10143-003-0289-2

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  • DOI: https://doi.org/10.1007/s10143-003-0289-2

Keywords

  • Epilepsy
  • Intracranial EEG
  • Neuroradiology
  • SPECT
  • Surgery