Ictal brain imaging in presurgical evaluation of patients with medically intractable complex partial seizures

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

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

At the Indiana University Medical Center, 99 patients with medically intractable complex partial seizures (MI-CPS) had presurgical evaluation with subsequent anterior temporal lobectomy. The majority of the patients had single photon emission tomography (SPECT) performed interictally as well as during an actual epileptic seizure (ictal scan). Decreased regional cerebral perfusion (rCP) was seen in 54/94 (57%) of the interictal scans corresponding to the eventual site of the surgery. However, ictal scans provided a higher yield; increased rCP in the temporal lobe during an actual seizure was observed in 60/82 (73%) concordant to the side of surgery. SPECT is a useful, noninvasive method of localizing the epileptiform focus in patients with MI-CPS considered for resective surgery. Both interictal and ictal SPECT need to be performed; combined interictal hypoperfusion and ictal hyperperfusion in the same focal area are unique to epileptogenic lesions. Ictal SPECT studies can be performed in the majority of patients during the period of continuous video/EEG monitoring with only a little additional effort. Combining the results of functional brain imaging (interictal and ictal SPECT, PET) with clinical semiology of seizures, surface and sphenoidal EEG, magnetic resonance imaging and other non-invasive tests, anterior temporal lobectomy can be recommended in approximately two-thirds of the patients without resorting to potentially dangerous intracranial EEG monitoring.

Original languageEnglish
Pages (from-to)137-144
Number of pages8
JournalActa Neurologica Scandinavica, Supplement
Volume89
Issue number152
StatePublished - 1994

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Neuroimaging
Single-Photon Emission-Computed Tomography
Seizures
Stroke
Anterior Temporal Lobectomy
Electroencephalography
Perfusion
Functional Neuroimaging
Temporal Lobe
Photons
Epilepsy
Tomography
Magnetic Resonance Imaging

Keywords

  • Anterior temporal lobectomy
  • Complex partial seizures
  • ictal SPECT

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Ictal brain imaging in presurgical evaluation of patients with medically intractable complex partial seizures. / Markand, Omkar; Salanova, Vicenta; Worth, R. M.; Park, H. M.; Wellman, H. H.

In: Acta Neurologica Scandinavica, Supplement, Vol. 89, No. 152, 1994, p. 137-144.

Research output: Contribution to journalArticle

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