Comparative study of interictal PET and ictal SPECT in complex partial seizures

Omkar Markand, Vicenta Salanova, R. Worth, H. M. Park, H. N. Wellman

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Objective - To compare the sensitivity of ictal 99mTc-HMPAO single photon emission computed tomography (SPECT) with interictal 18F-fluorodeoxyglucose positron emission tomography (PET) in localization of the epileptogenic focus in patients with medically intractable complex partial seizures (MI-CPS). Material and methods - Retrospective analysis was performed on patients with MI-CPS who underwent anterior temporal lobectomy from January 1993 onwards when PET became available to us for clinical studies at the Indiana University Medical Center. There were 38 female and 29 male patients (total=67) with MI-CPS, 10 to 55.5 years of age (mean 31) and duration of their epilepsy from 1-46 years (mean 21). Interictal PET was evaluated for evidence of local hypometabolism and ictal SPECT for focal perfusion abnormality (hyperperfusion or hypoperfusion) by visual analysis. Results - Both ictal SPECT and interictal FDG-PET studies were obtained in 36 patients with MI-CPS. PET showed definite hypometabolism in 30 and questionable hypometabolism in an additional two patients. Ictal SPECT correctly localized the seizure focus in 27 patients by demonstrating ictal hyperperfusion whereas in one the hyperperfusion was falsely localized. In an additional seven patients the ictal SPECT provided probable localization by demonstrating ictal hypoperfusion in the appropriate temporal lobe. The sensitivity of ictal SPECT and interictal PET was 34/36 and 32/36, respectively, the difference was not statistically significant (χ(y)2=0.18, DF=1, P=0.67). In six of the 36 patients the two tests were complementary to each other in providing localizing information. Conclusion - Ictal SPECT and interictal PET are equally sensitive and reliable techniques in localizing the epileptogenic focus in patients with MI-CPS. They play a critical role in providing localization in MRI negative patients allowing surgical resection to be undertaken in many without additional invasive electrographic monitoring.

Original languageEnglish
Pages (from-to)129-136
Number of pages8
JournalActa Neurologica Scandinavica
Volume95
Issue number3
StatePublished - 1997

Fingerprint

Single-Photon Emission-Computed Tomography
Positron-Emission Tomography
Seizures
Stroke
Anterior Temporal Lobectomy
Technetium Tc 99m Exametazime
Fluorodeoxyglucose F18
Temporal Lobe
Epilepsy
Perfusion

Keywords

  • anterior temporal lobectomy
  • complex partial seizures
  • ictal SPECT
  • interictal PET
  • presurgical evaluation

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Comparative study of interictal PET and ictal SPECT in complex partial seizures. / Markand, Omkar; Salanova, Vicenta; Worth, R.; Park, H. M.; Wellman, H. N.

In: Acta Neurologica Scandinavica, Vol. 95, No. 3, 1997, p. 129-136.

Research output: Contribution to journalArticle

@article{6f629f69ec314bafbce12a7a2e64625d,
title = "Comparative study of interictal PET and ictal SPECT in complex partial seizures",
abstract = "Objective - To compare the sensitivity of ictal 99mTc-HMPAO single photon emission computed tomography (SPECT) with interictal 18F-fluorodeoxyglucose positron emission tomography (PET) in localization of the epileptogenic focus in patients with medically intractable complex partial seizures (MI-CPS). Material and methods - Retrospective analysis was performed on patients with MI-CPS who underwent anterior temporal lobectomy from January 1993 onwards when PET became available to us for clinical studies at the Indiana University Medical Center. There were 38 female and 29 male patients (total=67) with MI-CPS, 10 to 55.5 years of age (mean 31) and duration of their epilepsy from 1-46 years (mean 21). Interictal PET was evaluated for evidence of local hypometabolism and ictal SPECT for focal perfusion abnormality (hyperperfusion or hypoperfusion) by visual analysis. Results - Both ictal SPECT and interictal FDG-PET studies were obtained in 36 patients with MI-CPS. PET showed definite hypometabolism in 30 and questionable hypometabolism in an additional two patients. Ictal SPECT correctly localized the seizure focus in 27 patients by demonstrating ictal hyperperfusion whereas in one the hyperperfusion was falsely localized. In an additional seven patients the ictal SPECT provided probable localization by demonstrating ictal hypoperfusion in the appropriate temporal lobe. The sensitivity of ictal SPECT and interictal PET was 34/36 and 32/36, respectively, the difference was not statistically significant (χ(y)2=0.18, DF=1, P=0.67). In six of the 36 patients the two tests were complementary to each other in providing localizing information. Conclusion - Ictal SPECT and interictal PET are equally sensitive and reliable techniques in localizing the epileptogenic focus in patients with MI-CPS. They play a critical role in providing localization in MRI negative patients allowing surgical resection to be undertaken in many without additional invasive electrographic monitoring.",
keywords = "anterior temporal lobectomy, complex partial seizures, ictal SPECT, interictal PET, presurgical evaluation",
author = "Omkar Markand and Vicenta Salanova and R. Worth and Park, {H. M.} and Wellman, {H. N.}",
year = "1997",
language = "English",
volume = "95",
pages = "129--136",
journal = "Acta Neurologica Scandinavica",
issn = "0001-6314",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Comparative study of interictal PET and ictal SPECT in complex partial seizures

AU - Markand, Omkar

AU - Salanova, Vicenta

AU - Worth, R.

AU - Park, H. M.

AU - Wellman, H. N.

PY - 1997

Y1 - 1997

N2 - Objective - To compare the sensitivity of ictal 99mTc-HMPAO single photon emission computed tomography (SPECT) with interictal 18F-fluorodeoxyglucose positron emission tomography (PET) in localization of the epileptogenic focus in patients with medically intractable complex partial seizures (MI-CPS). Material and methods - Retrospective analysis was performed on patients with MI-CPS who underwent anterior temporal lobectomy from January 1993 onwards when PET became available to us for clinical studies at the Indiana University Medical Center. There were 38 female and 29 male patients (total=67) with MI-CPS, 10 to 55.5 years of age (mean 31) and duration of their epilepsy from 1-46 years (mean 21). Interictal PET was evaluated for evidence of local hypometabolism and ictal SPECT for focal perfusion abnormality (hyperperfusion or hypoperfusion) by visual analysis. Results - Both ictal SPECT and interictal FDG-PET studies were obtained in 36 patients with MI-CPS. PET showed definite hypometabolism in 30 and questionable hypometabolism in an additional two patients. Ictal SPECT correctly localized the seizure focus in 27 patients by demonstrating ictal hyperperfusion whereas in one the hyperperfusion was falsely localized. In an additional seven patients the ictal SPECT provided probable localization by demonstrating ictal hypoperfusion in the appropriate temporal lobe. The sensitivity of ictal SPECT and interictal PET was 34/36 and 32/36, respectively, the difference was not statistically significant (χ(y)2=0.18, DF=1, P=0.67). In six of the 36 patients the two tests were complementary to each other in providing localizing information. Conclusion - Ictal SPECT and interictal PET are equally sensitive and reliable techniques in localizing the epileptogenic focus in patients with MI-CPS. They play a critical role in providing localization in MRI negative patients allowing surgical resection to be undertaken in many without additional invasive electrographic monitoring.

AB - Objective - To compare the sensitivity of ictal 99mTc-HMPAO single photon emission computed tomography (SPECT) with interictal 18F-fluorodeoxyglucose positron emission tomography (PET) in localization of the epileptogenic focus in patients with medically intractable complex partial seizures (MI-CPS). Material and methods - Retrospective analysis was performed on patients with MI-CPS who underwent anterior temporal lobectomy from January 1993 onwards when PET became available to us for clinical studies at the Indiana University Medical Center. There were 38 female and 29 male patients (total=67) with MI-CPS, 10 to 55.5 years of age (mean 31) and duration of their epilepsy from 1-46 years (mean 21). Interictal PET was evaluated for evidence of local hypometabolism and ictal SPECT for focal perfusion abnormality (hyperperfusion or hypoperfusion) by visual analysis. Results - Both ictal SPECT and interictal FDG-PET studies were obtained in 36 patients with MI-CPS. PET showed definite hypometabolism in 30 and questionable hypometabolism in an additional two patients. Ictal SPECT correctly localized the seizure focus in 27 patients by demonstrating ictal hyperperfusion whereas in one the hyperperfusion was falsely localized. In an additional seven patients the ictal SPECT provided probable localization by demonstrating ictal hypoperfusion in the appropriate temporal lobe. The sensitivity of ictal SPECT and interictal PET was 34/36 and 32/36, respectively, the difference was not statistically significant (χ(y)2=0.18, DF=1, P=0.67). In six of the 36 patients the two tests were complementary to each other in providing localizing information. Conclusion - Ictal SPECT and interictal PET are equally sensitive and reliable techniques in localizing the epileptogenic focus in patients with MI-CPS. They play a critical role in providing localization in MRI negative patients allowing surgical resection to be undertaken in many without additional invasive electrographic monitoring.

KW - anterior temporal lobectomy

KW - complex partial seizures

KW - ictal SPECT

KW - interictal PET

KW - presurgical evaluation

UR - http://www.scopus.com/inward/record.url?scp=0030939944&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030939944&partnerID=8YFLogxK

M3 - Article

VL - 95

SP - 129

EP - 136

JO - Acta Neurologica Scandinavica

JF - Acta Neurologica Scandinavica

SN - 0001-6314

IS - 3

ER -