Abstract
The effectiveness of surgery in patients with refractory complex partial seizures depends on accurate localisation of the epileptogenic zone. To assess the correlation between magnetic resonance imaging (MRI) hippocampal volume measurements, Tc 99m-hexamethyl-propyleneamineoxime inter- and postictal single photon emission computed tomography (SPECT) and clinico-electrophysiological (video/EEG) localisation of the epileptogenic zone we prospectively studied 16 consecutive patients with refractory complex partial seizures and no significant abnormality on standard MRI. Each test was interpreted blindly by independent observers. Eight patients (50%) had asymmetrical hippocampal volumes indicative of unilateral atrophy; correlation with the video/EEG and postical SPECT changes was very high (100% with definitive video/EEG localisation, 75% with interictal EEG and 83% with postictal SPECT). Moreover, the left/right hippocampal ratio was able to differentiate temporal from extratemporal video/EEG localisations. Postictal SPECT showed regional lateralised changes in 9 (64%) of 14 technically satisfactory studies. Disagreement between the video/EEG and postictal SPECT was seen with two extratemporal and one bitemporal foci.
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References
Engel J Jr (1987) Approaches to localization of the epileptogenic lesion. In: Engel J Jr, ed. Surgical treatment of the epilepsies. Raven Press, New York, pp 75–95
Engel J Jr, Henry TR, Risinger MW, et al (1990) Presurgical evaluation for partial epilepsy: relative contributions of chronic depth-electrode recordings versus FDG-PET and scalp-sphenoidal ictal EEG. Neurology 40: 1670–1677
Rougier A, Richer F, Martínez M, et al (1992) Surgical results. Evaluation and surgical treatment of the epilepsies. Neurochirurgie 38 (Suppl 1): 79–97
Brooks BS, King DW, Gammal TE, et al (1990) MR imaging in patients with intractable complex partial epileptic seizures. AJNR 11: 93–99
Boon P, Williamson P, Fried I, et al (1991) Intracranial, intraxial space-occupying lesions in patients with intractable partial seizures: an anatomoclinical, neuropsychological and surgical correlation. Epilepsia 32: 467–476
Bab TL, Brown WJ (1987) Pathological findings in epilepsy. In: Engel J Jr, ed. Surgical treatment of the epilepsies, Raven Press, New York, pp 511–552
Naidich TP, Daniels DL, Haughton VM, et al (1987) Hippocampal formation and related structures of the limbic lobe: anatomic-MR correlation. Part 1. Surface features and coronal sections. Radiology 162: 747–754
Naidich TP, Daniels DL, Haughton VM, et al (1987) Hippocampal formation and related structures of the limb lobe: anatomic-MR correlation, part 2. Sagittal sections. Radiology 162: 755–761
Jack CR Jr, Gehring DC, Shabrough FW, et al (1988) Temporal lobe volume measurement from MR images: accuracy and left-right asymmetry in normal persons. J Comput Assist Tomogr 12: 21–29
Jack CR Jr, Twomey CK, Zinsmeister AR, et al (1989) Anterior temporal lobes and hippocampal formations: normative volumetric measurements from MR images in young adults. Radiology 172: 549–554
Jack CR Jr, Bentley MD, Twomey CK, et al (1990) MR imaging-based volume measurements of the hippocampal formation and anterior temporal lobe: validation studies. Radiology 176: 205–209
Sperling MR, Sutherling WW, Nower RR (1987) New techniques for evaluating patients for epilepsy surgery. In: Engel J Jr (ed). Surgical treatment of the epilepsies. Raven Press, New York, pp 235–257
Ryvlin P, Philippon B, Cinotti L, et al (1992) Functional neuro-imaging strategy in temporal lobe epilepsy: a comparative study of 18-FDG-PET and 99m Tc-HMPAO-SPECT. Ann Neurol 31: 650–656
Stefan H, Pawlik G, Brocher-Schwartz HG (1987) Functional and morphological abnormalities in temporal lobe epilepsy: a comparison of interictal and ictal EEG, CT, MRI, SPECT and PET. J Neurol 234: 377–384
Rowe CC, Berkovic SF, Sia STB, et al (1989) Localization of epileptic foci with postictal single photon emission computed tomography. Ann Neurol 26: 660–668
Stefan H, Bauer J, Feistel H, et al (1990) Regional cerebral blood flow during focal seizures of temporal and frontocentral onset. Ann Neurol 27: 162–166
Jack CR Jr, Sharbrough FW, Twomey CK, et al (1990) Temporal lobe seizures: lateralization with MR volume measurements of the hippocampal formation. Radiology 175: 423–429
Cascino GD, Jack CR Jr, Parisi JE, et al (1991) Magnetic resonance imaging-based volume studies in temporal lobe epilepsy: pathological correlations. Ann Neurol 30: 31–36
Jack CR Jr, Sharbrough FW, Cascino GD, et al (1992) Magnetic resonance image-based hippocampal volumetry: correlation with outcome after temporal lobectomy. Ann Neurol 31: 138–146
Lencz T, McCarthy G, Bronen RA, et al (1992) Quantitative magnetic resonance imaging in temporal lobe epilepsy: relationship to neuropathology and neuropsychological function. Ann Neurol 31: 629–537
Rowe CC, Berkovic SF, Austin MC, et al (1991) Patterns of postictal cerebral blood flow in temporal lobe epilepsy: qualitative and quantitative analysis. Neurology 41: 1096–1103
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
Sperling MR, Wilson G, Engel J Jr, et al (1987) Magnetic resonance in intractable partial epilepsy: correlative studies. Ann Neurol 20: 57–62
Jackson GD, Berkovic SF, Tress BM, et al (1990) Hippocampal sclerosis can be reliably detected by magnetic resonance imaging. Neurology 40: 1869–1875
Spencer SS, Spencer DD, Williamson PD, Mattson RH (1982) The localizing value of depth electroencephalography in 32 patients with refractory epilepsy. Ann Neurol 12: 248–253
Spencer SS, Williamson PD, Bridgers SL, et al (1985) Reliability and accuracy of localization by scalp ictal EEG. Neurology 35: 1567–1575
Risinger MW, Engel J Jr, Van Ness PC, Henry TR, Crandall PH (1989) Ictal localization of temporal lobe seizures with scalp/sphenoidal recordings. Neurology 39: 1288–1293
Sperling MR, O'Connor MJ, Saykin AJ, et al (1992) A noninvasive protocol for anterior temporal lobectomy. Neurology 42: 416–422
Saint-Hilaire JM, Richer F, Martínez M (1992) Valeur de prédiction des tests noninvasifs. Neurochirurgie 39 (Suppl 1) 66
Ryvlin P, García-Larrea L, Philippon B et al (1992) High signal intensity on T2-weighted MRI correlates with hypoperfusion in temporal lobe epilepsy. Epilepsia 33: 28–35
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Martínez, M., Santamaría, J., Mercader, J.M. et al. Correlation of MRI hippocampal volume analysis, video/EEG monitoring and inter- and postictal single photon emission tomography in refractory focal epilepsy. Neuroradiology 36, 11–16 (1994). https://doi.org/10.1007/BF00599185
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DOI: https://doi.org/10.1007/BF00599185