Comparative Analysis of MR Imaging, Ictal SPECT and EEG in Temporal Lobe Epilepsy: a Prospective IAEA Multi-center Study

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2007 Sep 28

PMID 17899076

Citations 9

Authors

John J Zaknun

Chandrasekhar Bal

Alex Maes

Supatporn Tepmongkol

Silvia Vazquez

Patrick Dupont

Maurizio Dondi

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: MR imaging, ictal single-photon emission CT (SPECT) and ictal EEG play important roles in the presurgical localization of epileptic foci. This multi-center study was established to investigate whether the complementary role of perfusion SPECT, MRI and EEG for presurgical localization of temporal lobe epilepsy could be confirmed in a prospective setting involving centers from India, Thailand, Italy and Argentina.

Methods: We studied 74 patients who underwent interictal and ictal EEG, interictal and ictal SPECT and MRI before surgery of the temporal lobe. In all but three patients, histology was reported. The clinical outcome was assessed using Engel's classification. Sensitivity values of all imaging modalities were calculated, and the add-on value of SPECT was assessed.

Results: Outcome (Engel's classification) in 74 patients was class I, 89%; class II, 7%; class III, 3%; and IV, 1%. Regarding the localization of seizure origin, sensitivity was 84% for ictal SPECT, 70% for ictal EEG, 86% for MRI, 55% for interictal SPECT and 40% for interictal EEG. Add-on value of ictal SPECT was shown by its ability to correctly localize 17/22 (77%) of the seizure foci missed by ictal EEG and 8/10 (80%) of the seizure foci not detected by MRI.

Conclusions: This prospective multi-center trial, involving centers from different parts of the world, confirms that ictal perfusion SPECT is an effective diagnostic modality for correctly identifying seizure origin in temporal lobe epilepsy, providing complementary information to ictal EEG and MRI.

Citing Articles

CT perfusion measurement of postictal hypoperfusion: localization of the seizure onset zone and patterns of spread.

Li E, dEsterre C, Gaxiola-Valdez I, Lee T, Menon B, Peedicail J Neuroradiology. 2019; 61(9):991-1010.

PMID: 31152191 DOI: 10.1007/s00234-019-02227-8.

Seizure onset zone localization using postictal hypoperfusion detected by arterial spin labelling MRI.

Gaxiola-Valdez I, Singh S, Perera T, Sandy S, Li E, Federico P Brain. 2017; 140(11):2895-2911.

PMID: 29053782 PMC: 5841204. DOI: 10.1093/brain/awx241.

Functional neuro-imaging as a pre-surgical tool in epilepsy.

Haneef Z, Chen D Ann Indian Acad Neurol. 2014; 17(Suppl 1):S56-64.

PMID: 24791091 PMC: 4001213. DOI: 10.4103/0972-2327.128659.

Multimodal neuroimaging in presurgical evaluation of drug-resistant epilepsy.

Zhang J, Liu W, Chen H, Xia H, Zhou Z, Mei S Neuroimage Clin. 2013; 4:35-44.

PMID: 24282678 PMC: 3840005. DOI: 10.1016/j.nicl.2013.10.017.

[Neuroimaging of epilepsies].

Vollmar C, Fougere C Nervenarzt. 2012; 83(2):167-71.

PMID: 22349768 DOI: 10.1007/s00115-011-3334-3.

References

Shukla G, Bhatia M, Singh V, Jaiswal A, Tripathi M, Gaikwad S . Successful selection of patients with intractable extratemporal epilepsy using non-invasive investigations. Seizure. 2003; 12(8):573-6. DOI: 10.1016/s1059-1311(03)00084-0. View

Helmstaedter C, Kurthen M, Lux S, Reuber M, Elger C . Chronic epilepsy and cognition: a longitudinal study in temporal lobe epilepsy. Ann Neurol. 2003; 54(4):425-32. DOI: 10.1002/ana.10692. View

Breier J, Mullani N, Thomas A, Wheless J, Plenger P, Gould K . Effects of duration of epilepsy on the uncoupling of metabolism and blood flow in complex partial seizures. Neurology. 1997; 48(4):1047-53. DOI: 10.1212/wnl.48.4.1047. View

Jokeit H, Ebner A, Arnold S, Schuller M, Antke C, Huang Y . Bilateral reductions of hippocampal volume, glucose metabolism, and wada hemispheric memory performance are related to the duration of mesial temporal lobe epilepsy. J Neurol. 1999; 246(10):926-33. DOI: 10.1007/s004150050484. View

Lancman M, Morris 3rd H, Raja S, Sullivan M, Saha G, Go R . Usefulness of ictal and interictal 99mTc ethyl cysteinate dimer single photon emission computed tomography in patients with refractory partial epilepsy. Epilepsia. 1997; 38(4):466-71. DOI: 10.1111/j.1528-1157.1997.tb01737.x. View

Cucherat M . [Meta-analysis of surgery trials in refractory epilepsy]. Rev Neurol (Paris). 2004; 160 Spec No 1:5S232-40. View

Lee S, Lee S, Kim S, Lee D, Kim H . The clinical usefulness of ictal SPECT in temporal lobe epilepsy: the lateralization of seizure focus and correlation with EEG. Epilepsia. 2000; 41(8):955-62. DOI: 10.1111/j.1528-1157.2000.tb00278.x. View

Deasy N, Jarosz J, Elwes R, Polkey C, Cox T . Thalamic changes with mesial temporal sclerosis: MRI. Neuroradiology. 2000; 42(5):346-51. DOI: 10.1007/s002340050896. View

Radhakrishnan K, So E, Silbert P, Jack Jr C, Cascino G, Sharbrough F . Predictors of outcome of anterior temporal lobectomy for intractable epilepsy: a multivariate study. Neurology. 1998; 51(2):465-71. DOI: 10.1212/wnl.51.2.465. View

10.

Spencer S . The relative contributions of MRI, SPECT, and PET imaging in epilepsy. Epilepsia. 1994; 35 Suppl 6:S72-89. DOI: 10.1111/j.1528-1157.1994.tb05990.x. View

11.

Nohria V, Lee N, Tien R, Heinz E, Smith J, Delong G . Magnetic resonance imaging evidence of hippocampal sclerosis in progression: a case report. Epilepsia. 1994; 35(6):1332-6. DOI: 10.1111/j.1528-1157.1994.tb01807.x. View

12.

Spanaki M, Kopylev L, DeCarli C, Gaillard W, Liow K, Fazilat S . Postoperative changes in cerebral metabolism in temporal lobe epilepsy. Arch Neurol. 2000; 57(10):1447-52. DOI: 10.1001/archneur.57.10.1447. View

13.

Berkovic S, McIntosh A, Kalnins R, Jackson G, Fabinyi G, Brazenor G . Preoperative MRI predicts outcome of temporal lobectomy: an actuarial analysis. Neurology. 1995; 45(7):1358-63. DOI: 10.1212/wnl.45.7.1358. View

14.

Ho S, Berkovic S, Newton M, Austin M, McKay W, Bladin P . Parietal lobe epilepsy: clinical features and seizure localization by ictal SPECT. Neurology. 1994; 44(12):2277-84. DOI: 10.1212/wnl.44.12.2277. View

15.

Fuerst D, Shah J, Shah A, Watson C . Hippocampal sclerosis is a progressive disorder: a longitudinal volumetric MRI study. Ann Neurol. 2003; 53(3):413-6. DOI: 10.1002/ana.10509. View

16.

Hwang S, Kim J, Park S, Han M, Yu I, Lee S . Comparative analysis of MR imaging, positron emission tomography, and ictal single-photon emission CT in patients with neocortical epilepsy. AJNR Am J Neuroradiol. 2001; 22(5):937-46. PMC: 8174931. View

17.

Ho S, Berkovic S, McKay W, Kalnins R, Bladin P . Temporal lobe epilepsy subtypes: differential patterns of cerebral perfusion on ictal SPECT. Epilepsia. 1996; 37(8):788-95. DOI: 10.1111/j.1528-1157.1996.tb00653.x. View

18.

Duncan R, Biraben A, Patterson J, Hadley D, Bernard A, Lecloirec J . Ictal single photon emission computed tomography in occipital lobe seizures. Epilepsia. 1997; 38(7):839-43. DOI: 10.1111/j.1528-1157.1997.tb01472.x. View

19.

Henry T, Van Heertum R . Positron emission tomography and single photon emission computed tomography in epilepsy care. Semin Nucl Med. 2003; 33(2):88-104. DOI: 10.1053/snuc.2003.127301. View

20.

Koslowsky I, Brake S, Bitner S . Evaluation of the stability of (99m)Tc-ECD and stabilized (99m)Tc-HMPAO stored in syringes. J Nucl Med Technol. 2002; 29(4):197-200. View