-
-
J Korean Neurol Assoc. 1997;15(4):762-774.
- The Usefulness of Ictal SPECT in Preoperative Localization of Neocortical Epileptic Foci
-
Hee-joon Bae, M.D., Hyun-woo Nam, M.D., & Sang-kun Lee, M.D.,
-
Department of Neurology, Seoul National University Hospital & Boramae City Hospital
- 난치성 신피질성 간질 환자의 수술 전 검사에서 발작기 SPECT의 유용성
-
배희준, 남현우, 이상건
-
서울대학교 의과대학 신경과학교실, 서울특별시립 보라매병원 신경과
- Abstract
- Rationale : Studies on ictal SPECT as a method of presurgical evaluation in neocortical epilepsy have been rare and inadequate. We evaluated the accuracy in the localization of epileptic foci with ictal SPECT in neocortical epilepsy and tried to find out the determining factors of its accuracy.
Methods
: We performed ictal SPECT 66 times with 99m-Tc-HMPAO in 56 patients,
who received video-EEG monitoring and had electroclinical features of neocortical
epilepsy. Invasive monitoring was performed in 28 patients & epileptic surgery was
done in 31. Their results were also used to help determine the location of epileptic foci.
In 54 of 66 scans data about injection time and temporal relationship of HMPAO
injection to the onset and secondary generalization of seizures were available.
Results
: Frontal lobe epilepsy(FLE) was most common(35%) followed by lateral
temporal lobe epilepsy(28%), occipital lobe epilepsy(11%), parietal lobe epilepsy(9%), and
etc.
Ictal SPECT demonstrated unilateral hyperperfusion in 53 of 66 scans (80.3 %) which
were concordant with electroclinical lateralization in 48 of 53 (90.6 %). Localized
hyperperfusion was evident in 42 of 66 scans (63.6 %) which were concordant with
electroclinical localization in 33 of 42(78.6 %).
Correctly localized hyperperfusion or correctly-lateralized but diffuse hyperperfusion
were detected in 37 of 54 scans in which data about injection time were available. The
mean injection time was 32.1 seconds. In 16 scans ictal SPECT showed no
hyperperfusion or falsely localized/lateralized hyperperfusion. Their mean injection time
was 41.6 seconds. The difference of injection time between two groups was not
significant(p-value=0.07), but there was a tendency that the mean injection time of the
former group was earlier than that of the latter group. We had chances to perform
ictal SPECT repeatedly in 8 patients under the similar conditions. The fact that earlier
injection improved the accuracy of ictal SPECT in 6 patients supports the importance of
early injection.
In 48 studies with ictal injection, only 11 scans gave no or incorrect information of
the localization or lateralization of epileptic foci. But, in 6 studies with postictal
injection, 5 scans was not helpful. The difference between two groups was statistically
significant(p<0.05). The presence of focal lesion, the location of epileptic foci, or
secondary generalization did not influence the accuracy of ictal SPECT.
Conclusions : Our data suggest that ictal SPECT in neocortical epilepsy is useful in
localization of epileptic foci. Whether injected ictally or postictally and the injection time
from seizure onset seems to influence the accuracy of ictal SPECT in neocortical
epilepsy.
Keywords :
- 초록
-
