HIPDM-SPECT in Patients With Medically Intractable Complex Partial Seizures

Lee, B. I.; Markand, Omkar N.; Wellman, Henry N.; Siddiqui, Aslam R.; Park, H. M.; Mock, Bruce H.; Worth, Robert M.; Edwards, Mary K.; Krepshaw, J.

doi:10.1001/archneur.1988.00520280043014

Cited by 125 publications

(46 citation statements)

References 14 publications

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“…Interictal measurement of brain metabolism with deoxyglucose and PET has been reported to localize the epileptic focus in 70-90% of patients with complex partial seizures (1-11). This does not hold true for interictal blood flow measurements with SPECT and hexamethylpropylene amine oxime (HMPAO), or with PET and "0-labeling (10,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Blood-flow measurements do, however, contribute to focus localization when used as a marker of ictal epileptogenic activity (10,18,(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

Uncoupling of Blood Flow and Metabolism in Focal Epilepsy

Bruehl¹,

Hagemann²,

Witte³

1998

Epilepsia

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Summary:Purpose: Interictal measurements of cerebral blood flow are less helpful in localizing epileptic foci than are measurements of brain metabolism. This may be related to an uncoupling of blood flow and metabolism. In this study, brain metabolism and blood flow were compared in an acute experimental model of focal interictal epilepsy.Methods: Interictal epileptic foci were induced by an epicortical application of penicillin in rats. After 1 h, stereotyped interictal activity was initiated, lasting until the end of the experiment. Brain metabolism was determined with [ ''C]deoxyglucose, and cerebral blood flow with [ ''C]iodoantipyrine autoradiography.Results: In control experiments, metabolism and blood flow were coupled. In animals with focal interictal epileptic activity, the metabolism was strongly increased in the focus and reduced in areas lateral to the focus. In contralateral brain areas, blood flow and metabolism varied in a parallel fashion. Ipsilateral to the focus, however, blood flow and metabolism were altered disproportionately. In the focus, the increase of blood flow was less marked than the increase of metabolism, and the area with increased blood flow was larger than the area with increased metabolism. Lateral to the focus, in the area with a hypometabolism, blood flow was not concomitantly reduced. Conclusions:The experiments show that blood flow and rnetabolism in focal epilepsy may be uncoupled in widespread regions. This is due neither to structural abnormalities nor to the duration or discharge pattern of epileptic activity. The results explain why interictal metabolic investigations have a higher predictive value in presurgical epilepsy evaluation than do interictal measurements of blood flow. Key Words: Epilepsy-Epileptic focus-Deoxyglucose-AutoradiographyHypometabolism-Blood flow-Iodoantipyrine-PenicillinInterictal-PET-SPECT.Patients with focal epilepsy refractory to treatment with antiepileptic drugs (AEDs) can often profit from surgery if the epileptic focus can be exactly delineated. With the advent of new functional imaging technologies, including positron emission tomography (PET) and single-photon-emission computed tomography (SPECT), invasive presurgical .epilepsy evaluation has become unnecessary in a growing number of patients. Interictal measurement of brain metabolism with deoxyglucose and PET has been reported to localize the epileptic focus in 70-90% of patients with complex partial seizures (1-11). This does not hold true for interictal blood flow measurements with SPECT and hexamethylpropylene amine oxime (HMPAO), or with PET and "0-labeling (10,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Blood-flow measurements do, however, contribute to focus localization when used as a marker of ictal epileptogenic activity (10,18,(22)(23)(24).Because blood flow and metabolism are usually assumed to be coupled (25)(26)(27), the discrepancy between Accepted April 9, 1998. Address correspondence and reprint requests to Dr. 0. W. Witte at Neurologische Klinik, Heinrich-Heine-Universita...

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Section: Discussionmentioning

confidence: 99%

Uncoupling of Blood Flow and Metabolism in Focal Epilepsy

Bruehl¹,

Hagemann²,

Witte³

1998

Epilepsia

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“…This is clearly demonstrated by numerous PET and SPECT studies which have shown increased cerebral flow and metabolite consumption in the area of epileptic focus [7][8][9] . These fi ndings have been confi rmed by functional MRI, with important clinical implications 10 .…”

Section: Discussionmentioning

confidence: 89%

Hippocampal sclerosis and status epilepticus: cause or consequence? A MRI study

Kuster

Braga‐Neto

Santos-Neto

et al. 2007

Arq. Neuro-Psiquiatr.

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-Background: Transient imaging abnormalities, including changes on diffusion-weighted imaging (DWI), may be seen in status epilepticus. These abnormalities can be followed by hippocampal sclerosis. Case report: We report a 15-year-old lady with focal non convulsive status epilepticus (NCSE) and focal slowing on EEG. DWI exhibited abnormal hyperintense signals in bilateral temporal and insular cortices. After 3 weeks, MRI performed a localizated hippocampal atrophy. Conclusion: The MRI findings indicated vasogenic and cytotoxic edema during seizure activity and subsequent loss of brain parenchyma.KEY WORDS: status epilepticus, magnetic resonance imaging (MRI), diffusion-weighted images, reversible MRI abnormalities, hippocampal sclerosis.Esclerose hipocampal e status epilepticus: causa ou conseqüência? Um estudo de RM RESUMO -Introdução: Anormalidades transitórias de imagem, incluindo imagens de ressonância magné-tica por difusão (DWI), podem ser vistas no status epilepticus. Essas anormalidades podem ser seguidas de esclerose hipocampal. Relato de caso: Nós relatamos uma jovem de 15 anos com status focal não convulsivo e lentificação focal no EEG. DWI mostrava sinal hiperintenso em regiões temporais bilaterais e córtex insular. Após 3 semanas, RM de encéfalo mostrava atrofia localizada do hipocampo. Conclusão: Os achados de RM indicam edema vasogênico e citotóxico durante as crises epilépticas com subseqüente atrofia de parênquima cerebral. PALAVRAS-CHAVE: status epilepticus, ressonância nuclear magnética (RNM), sequência difusão, alterações reversíveis de RNM, esclerose hipocampal.

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“…Additionally, ictal onset baseline shifts and infraslow activity at <0.1 Hz has been shown to have localizing value in focal epilepsies [46]. PET and subtraction ictal SPECT studies have been used for many years to assist in localization of EZs, which are often hypometabolic on interictal PET and show increased ictal and decreased interictal regional perfusion by SPECT [47,48]. Direct comparison between MRI, FDG-PET, and subtraction ictal SPECT localization in neocortical epilepsy has shown variable sensitivity depending on the type of lesion, with higher sensitivity of PET and MRI compared to SPECT for tumor localization and higher sensitivity of PET and SPECT compared to MRI for neuronal migration disorders [49].…”

Section: Electrophysiology and Multimodal Imagingmentioning

confidence: 99%