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Ictal technetium-99 m ethyl cysteinate dimer single-photon emission tomographic findings in epileptic patients with polymicrogyria syndromes: A Subtraction of ictal–interictal SPECT coregistered to MRI study

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

Abstract

Purpose

To describe the ictal technetium-99 m-ECD SPECT findings in polymicrogyria syndromes (PMG) during epileptic seizures.

Methods

We investigated 17 patients with PMG syndromes during presurgical workup, which included long-term video-electroencephalographic (EEG) monitoring, neurological and psychiatry assessments, invasive EEG, and the subtraction of ictal–interictal SPECT coregistered to magnetic resonance imaging (MRI) (SISCOM).

Results

The analysis of the PMG cortex, using SISCOM, revealed intense hyperperfusion in the polymicrogyric lesion during epileptic seizures in all patients. Interestingly, other localizing investigations showed heterogeneous findings. Twelve patients underwent epilepsy surgery, three achieved seizure-freedom, five have worthwhile improvement, and four patients remained unchanged.

Conclusions

Our study strongly suggests the involvement of PMG in seizure generation or early propagation. Both conventional ictal single-photon emission computed tomography (SPECT) and SISCOM appeared as the single contributive exam to suggest the localization of the epileptogenic zone. Despite the limited number of resective epilepsy surgery in our study (n = 9), we found a strong prognostic role of SISCOM in predicting surgical outcome. This result may be of great value on surgical decision-making of whether or not the whole or part of the PMG lesion should be surgically resected.

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Acknowledgments

The authors thank the neurophysiologists, colleagues, nurses and technical staff of CIREP and of the Nuclear Medicine Department. Funding Sources: “The State of São Paulo Research Foundation”—FAPESP (Grant 04/14004—CInAPCe Program) and FAEPA/HCFMRP. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report has the approval of our institutional ethics committee.

Disclosure

The authors report no conflicts of interest.

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Authors and Affiliations

  1. Center for Epilepsy Surgery, Department of Neurology, Psychiatry and Clinical Psychology, University of São Paulo, Ribeirão Preto, Brazil

    Lauro Wichert-Ana, Regina Maria França Fernandes, Tonicarlo Rodrigues Velasco & Américo Ceiki Sakamoto

  2. Center for Imaging Science and Medical Physics, Department of Internal Medicine, University of São Paulo, Ribeirão Preto, Brazil

    Paulo Mazzoncini de Azevedo-Marques, Antonio Carlos Santos & David Araújo

  3. Division of Nuclear Medicine, Department of Internal Medicine from the Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil

    Mery Kato

  4. Neurology Division, HCPA, Rio Grande do Sul Federal University, Porto Alegre, RS, Brazil

    Marino Muxfeldt Bianchin

  5. Informatics Department, Federal University of Pelotas, Pelotas, RS, Brazil

    Lucas Ferrari Oliveira

  6. Centro de Cirurgia de Epilepsia, CIREP, Hospital das Clínicas, USP, Campus Universitário, Av. Bandeirantes 3900, Ribeirão Preto, CEP 14.048-900, SP, Brazil

    Lauro Wichert-Ana

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  1. Lauro Wichert-Ana
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  2. Paulo Mazzoncini de Azevedo-Marques
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Correspondence to Lauro Wichert-Ana.

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Wichert-Ana, L., de Azevedo-Marques, P.M., Oliveira, L.F. et al. Ictal technetium-99 m ethyl cysteinate dimer single-photon emission tomographic findings in epileptic patients with polymicrogyria syndromes: A Subtraction of ictal–interictal SPECT coregistered to MRI study. Eur J Nucl Med Mol Imaging 35, 1159–1170 (2008). https://doi.org/10.1007/s00259-007-0655-3

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  • DOI: https://doi.org/10.1007/s00259-007-0655-3

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