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Academia Mexicana de Neurología, A.C.

2005, Number 3

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Rev Mex Neuroci 2005; 6 (3)

Contribution of SPECT in the presurgical evaluation of pharmacoresistant temporal lobe epilepsy. CIREN experience

Morales CL, Sánchez CC, Águila A, Bender J, García I, García ME, Lorigados L

Language: Spanish
References: 30
Page: 250-256
PDF size: 282.95 Kb.


ABSTRACT

Objective: To show the contribution of interictal and ictal Single Photon Emission CT (SPECT) to localize the epileptogenical zone in patients with pharmacoresistant temporal lobe epilepsy (TLE). Methods and material: Included in the presurgical evaluation interictal and ictal SPECT scans were used to evaluate cerebral perfusion in 18 patients with pharmacoresistant TLE. Perfusion ratios were calculated on irregular regions of interest (ROI) drawn on lateral and mesial lobe, cerebellum and basal ganglia. Asymmetry indexes were calculated between homologous ROIs. Results: Visual analysis of cerebral perfusion detected focal hypoperfusion involving the whole temporal lobe in 100% of patients. The hypoperfusion was extended into the frontal lobe in 50% of them. Discriminant analysis using the ROIs measures showed that the changes in lateral temporal perfusion were the most suitable lateralizing measure. It was ipsilateral to the epileptogenic zone defined by surgery in 87.4% of patient χ2(2) = 8, p ‹ 0.0001. Interhemispheric asymmetry indexes of 13% and 28% were found in left and right TLE respectively. Ictal SPECT showed mesiolateral temporal lobe hyperperfusion ipsilateral to the epileptogenic zone in all evaluated patients and also demonstrated contralate-ral cerebelar activation in 25% of them. In addition ipsilateral basal ganglia activation was observed in 75%. Conclusion Interictal SPECT defined an extensive functional deficit zone in TLE patients. Ictal and interictal SPECT changes are a reliable lateralizing indicator of epileptogenic zone in TLE.


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