Neurosurgical Aspects of Epilepsy pp 95-99 | Cite as
Identification of the Side of the Epileptic Focus with 123I-Iomazenil SPECT
Summary
123 I-Iomazenil SPECT was performed in 17 patients who were considered candidates for surgery of epilepsy because of medically intractable complex partial seizures. In addition to this examination their presurgical evaluation consisted of long term ictal EEG-CCTV monitoring, CT, MRI and 18FDG PET. In eight patients intracranial ictal EEG recordings were performed.
SPECT was assessed visually while PET data were analyzed quantitatively. Both SPECT and PET were compared to ictal EEG data and showed asymmetries in over 80% of patients in agreement with EEG findings. These three methods were in agreement in 65% of patients. SPECT showed abnormality contralateral to the EEG focus in one patient (6%) while PET always demonstrated ipsilateral dysfunction.
It is concluded that 1231-Iomazenil SPECT may be considered a more economical and more widely available alternative to 18FDG PET in the presurgical evaluation of patients with medically intractable complex partial seizures. In this respect 123I-Iomazenil specifically reflects functional changes in the membranes of neurons while 18FDG is related to glucose metabolism not only of neurons but also of glial cells.
Keywords
Epilepsy epileptic focus identification SPECT 123I-Iomazenil 18FDG-PET ictal EEGPreview
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References
- 1.Andersen AR, Gram L, Kjaer L, Fuglsang-Frederiksen A, Heming M, Lassen NA, Dam M (1988) Spect in partial epilepsy: Identifying side of the focus. Acta Neurologica Scand [Suppl 117] 78: 90–95CrossRefGoogle Scholar
- 2.Burnham WM, Hwang PA, Hoffman HJ, Becker LE, Murphy EG, Kish SJ (1987) Benzodiazepine receptor binding in human epileptogenic cortical tissue. In: Engel J Jr et al (eds) Fundamental mechanisms of human brain function. Raven Press, New York, pp 277–235Google Scholar
- 3.Engel J (1988) The role of neuroimaging in the surgical treatment of epilepsy. Acta Neurol Scand [Suppl 117] 78: 84–89CrossRefGoogle Scholar
- 4.Franck G, Sadzot B, Salmon E, Depresseux JC, Grisar T, Peters JM, Guillaume M, Quaglia I, Delfiore G, Lamotte D (1986) Regional cerebral blood flow and metabolic rates in human focal epilepsy and status epilepticus. In: Delgado-Escueta AV et al (eds) Advances in neurology, Vol 44. Raven Press, New York, pp 935–948Google Scholar
- 5.Phelps ME, Huang SC, Hoffman EJ, Selin C, Sokoloff L, Kuhl DE (1979) Tomographic measurement of local cerebral glucose. Metabolic rate in humans with (F-18)2-fluoro-2-deoxy-d-glucose: validation of method. Ann Neurol 6: 371–388PubMedCrossRefGoogle Scholar
- 6.Podreka I, Lang W, Suess E, Wimberger D, Steiner M, Gradner W, Zeitlhofer J, Pelzl G, Mamoli B, Deecke L (1988) Hexamethyl-propylene-amine-oxime (HMPAO) Single photon emission computed tomography (SPECT) in epilepsy. Brain topography. J Funct Neurophysiol 1: 55–60CrossRefGoogle Scholar
- 7.Savic I, Roland P, Sedvall G, Persson A, Pauli S, Widén L (1988) In-vivo demonstration of reduced benzodiazepine receptor binding in human epileptic foci. Lancet pp 863–866Google Scholar
- 8.Sherwin A, Matthew E, Blain M, Guévremont D (1986) Benzodiazepine receptor binding is not altered in human epileptogenic cortical foci. Neurology 36: 1380–1382PubMedGoogle Scholar
- 9.Theodore WH, Fishbein D, Dubinsky R (1988) Pattern of cerebral glucose metabolism in patients with partial seizures. Neurology 38: 1201–1206PubMedGoogle Scholar