Acute effect of electroconvulsive therapy on brain perfusion assessed by Tc99m‐hexamethylpropyl‐eneamineoxim and single photon emission computed tomography

Bajc, Marika; Medved, Vesna; Basić, M; Topuzović, Nedeljko; Babić, Draženko; Ivančević, Darko

doi:10.1111/j.1600-0447.1989.tb03000.x

Cited by 29 publications

(11 citation statements)

References 19 publications

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“…The involvement of the whole brain in mECS is confirmed in the present study by the widespread increase in LCBF rates during the seizure. Our data are in accordance with previous studies reporting generalized increase in LCBF rates or cerebral metabolism during mECS in animals (19,20) and humans (19,21,22) and generalized c-fos mRNA increase after mECS (23).…”

Section: Mapping Of Brain Activation During Electroshock-induced Seizsupporting

confidence: 93%

Dynamic Variations of Local Cerebral Blood Flow in Maximal Electroshock Seizures in the Rat

2002

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Summary:Purpose: Measurement of cerebral blood flow is routinely used to locate the areas involved in generation and spread of seizures in epilepsy patients. Because the nature of the hyperperfused regions varies with the timing of injection of tracer, in this study, we used a rat model of maximal electroshock seizures to follow up the time-dependent changes in the distribution of seizure-induced cerebral blood flow (CBF) changes.Methods: CBF was measured by the quantitative autoradiographic [ 14 C]iodoantipyrine technique over a 30-s duration. The tracer was injected either at 15 s before seizure induction, simultaneous with the application of the electroshock (tonic phase), at the onset of the clonic phase, or at 3 and 6 min after the seizure (postictal phase).Results: Rates of CBF underwent dynamic changes during the different phases of seizure activity and largely increased over control levels (Յ400%) in the 45 regions studied during all phases of the seizure (first 3 times). CBF remained higher than control levels in 35 and 15 areas at 3 and 6 min after the seizure, respectively.Conclusions: The distribution of maximal CBF increases showed a good correlation with their known involvement in the circuits underlying the clinical expression of the different types of seizure activity, tonic versus clonic. Key Words: Cerebral blood flow-[ 14 C]iodoantipyrine-Seizures-Electroshock.A number of patients with symptomatic or cryptogenic epilepsies are medically intractable and need the surgical resection of the epileptic focus (1-3). The success of surgery depends substantially on the validity of the data used for the location of the seizure focus (4,5). The methods available to localize the epileptic focus include seizure characterization; neurologic examination; neuropsychological testing; magnetic resonance imaging; functional brain imaging of blood flow with singlephoton emission computed tomography (SPECT) and of glucose utilization with positron emission tomography (PET); video/scalp electroencephalographic (EEG) recording; and video electrocorticography (ECoG) with depth, subdural, or epidural electrodes (6,7).Most epilepsy centers tend to perform less-invasive monitoring (8) and use quite routinely local cerebral blood flow (LCBF) measurement by SPECT with hexamethylpropylene amine oxime (HMPAO) or ethyl cysteinate dimer (ECD) labeled with 99m-technetium. Ictal SPECT shows increased LCBF in the epileptic focus in ∼95% of patients with temporal lobe epilepsy (4,5,9,10).However, there has been considerable discussion regarding the optimal timing of early postictal LCBF analysis (5,11,12) since the nature of the territories hyperperfused during the seizure varies with the timing of injection of the tracer. Thus the recognition of the dynamic process of ictal brain perfusion alteration is essential for the application of ictal/postictal SPECT LCBF measurement to localize the epileptic focus and the secondary spread of seizures.Therefore we used an animal model of seizures induced by maximal electroshock to observe...

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Section: Mapping Of Brain Activation During Electroshock-induced Seizsupporting

confidence: 93%

Dynamic Variations of Local Cerebral Blood Flow in Maximal Electroshock Seizures in the Rat

2002

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“…Previous studies support the involvement of focal bilateral brain regions during generalized tonic–clonic seizures (Engel et al, 1978; Ackermann et al, 1986; Bajc et al, 1989; McIntyre et al, 1991; Handforth and Ackermann, 1995; Handforth and Treiman, 1995; McCown et al, 1995; Vollmer‐Haase et al, 1998; Andre et al, 2002). Our recent work both in humans and animal models demonstrates that generalized tonic–clonic seizures cause local activation of the lateral frontal and parietal association cortex, along with subcortical structures such as the thalamus (Blumenfeld et al, 2003a,b; McNally and Blumenfeld, 2004; Nersesyan et al, 2004a).…”

mentioning

confidence: 60%

Imaging Onset and Propagation of ECT‐induced Seizures

Enev¹,

McNally²,

Varghese³

et al. 2007

Epilepsia

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Summary:Purpose: Regions of seizure onset and propagation in human generalized tonic-clonic seizures are not well understood. Cerebral blood flow (CBF) measurements with single photon emission computed tomography (SPECT) during electroconvulsive therapy (ECT)-induced seizures provide a unique opportunity to investigate seizure onset and propagation under controlled conditions.Methods: ECT stimulation induces a typical generalized tonic-clonic seizure, resembling spontaneous generalized seizures in both clinical and electroencephalogram (EEG) manifestations. Patients were divided into two groups based on timing of ictal (during seizure) SPECT tracer injections: 0 s after ECT stimulation (early group), and 30 s after ECT (late group). Statistical parametric mapping (SPM) was used to determine regions of significant CBF changes between ictal and interictal scans on a voxel-by-voxel basis.Results: In the early injection group, we saw increases near the regions of the bitemporal stimulating electrodes as well as some thalamic and basal ganglia activation. With late injections, we observed increases mainly in the parietal and occipital lobes, regions that were quiescent 30 s prior. Significant decreases occurred only at the later injection time, and these were localized to the bilateral cingulate gyrus and left dorsolateral frontal cortex.Conclusions: Activations in distinct regions at the two time points, as well as sparing of intermediary brain structures, suggest that ECT-induced seizures propagate from the site of initiation to other specific brain regions. Further work will be needed to determine if this propagation occurs through corticalcortical or cortico-thalamo-cortical networks. A better understanding of seizure propagation mechanisms may lead to improved treatments aimed at preventing seizure generalization.

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“…Ictal SPECT is analyzed by comparison with baseline interictal SPECT in the same patients. 78,79 SPECT imaging of generalized tonic-clonic seizure has been done in both electroconvulsive therapy–induced seizures 80–85 and in spontaneous secondarily generalized seizures, 68,71,82,86–88 with similar results.…”

Section: Generalized Tonic-clonic Seizuresmentioning

confidence: 89%

Epilepsy and the Consciousness System: Transient Vegetative State?

Blumenfeld

2011

Neurologic Clinics

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Acute effect of electroconvulsive therapy on brain perfusion assessed by Tc99m‐hexamethylpropyl‐eneamineoxim and single photon emission computed tomography

Cited by 29 publications

References 19 publications

Dynamic Variations of Local Cerebral Blood Flow in Maximal Electroshock Seizures in the Rat

Dynamic Variations of Local Cerebral Blood Flow in Maximal Electroshock Seizures in the Rat

Imaging Onset and Propagation of ECT‐induced Seizures

Epilepsy and the Consciousness System: Transient Vegetative State?

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