Ictal SPECT in clinical perisylvian syndrome

Ahnlide, Jan Anders; Rosén, Ingmar; Källén, Kristina; Geijer, Bo

doi:10.1046/j.1600-0404.2003.00225.x

Cited by 7 publications

(6 citation statements)

References 5 publications

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“…2 In our patient, no structural pathology or other cause could be determined despite extensive investigations. In two similar cases with the electro-clinical findings of an opercular syndrome and perisylvian hyperperfusion in single photon emission tomography (SPECT), 13,14 one patient had a mild bilateral perisylvian cortical dysplasia, which was only detected in a SISCOM (subtraction of ictal from interictal SPECT and coregistration with MRI)-guided re-evaluation of the O PET during the ictal phase (white/green) and postictal simulation task (grey/red). The statistical parametric maps show higher activity during epileptic seizures.…”

Section: Discussionmentioning

confidence: 82%

Transient epileptic opercular syndrome

Mueller

Treyer

Kollias

et al. 2007

Seizure

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Ictal transient opercular syndrome is rarely observed in benign epilepsy with centro-temporal spikes in children, and even more rarely in epilepsia partialis continua and symptomatic focal status epilepticus in adults. Here we report the ictal and interictal neuroimaging and electrophysiological findings in an adult female suffering from discontinuous focal status epilepticus presenting as a transient opercular syndrome. This patient was unusual insofar as the discharges were strictly unilateral, i.e., that even with extensive neuroimaging no structural abnormalities could be found.

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Section: Discussionmentioning

confidence: 82%

Transient epileptic opercular syndrome

Mueller

Treyer

Kollias

et al. 2007

Seizure

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“…A recent case report from Cascino showed that SISCOM may be used in nonlesional epilepsy and alter the strategy for intracranial EEG recordings (Cascino et al, 2004). SISCOM findings can also guide a reevaluation of MRI in cases in which the MRI is initially considered normal (Ahnlide et al, 2004).…”

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confidence: 99%

Does SISCOM Contribute to Favorable Seizure Outcome after Epilepsy Surgery?

Ahnlide¹,

Rosén²,

Tech³

et al. 2007

Epilepsia

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Summary:Purpose: To assess the additional value of subtraction ictal single-photon emission computed tomography (SPECT) coregistered to MRI (SISCOM) for localization of the epileptogenic zone in patients with drug-resistant epilepsy scheduled for invasive video-EEG (VEEG) before epilepsy surgery by a descriptive study from clinical practice.Methods: Forty-nine consecutive epilepsy patients between January 2000 and March 2006 were included. Thirty-six of the 49 patients were offered surgery, and 34 underwent resective surgery during the study period. Localizing and outcome data are presented from 31 patients with a follow-up period of ≥12 months. Successful ictal SPECT was performed in 26 patients, and SISCOM showed significant hyperperfusions with 3.5 SD above reference. Twenty patients had SISCOM-guided electrode placement, invasive monitoring, and 1-year postsurgical followup data. Two independent epileptologists evaluated whether SISCOM results (a) altered the hypothesis and extended the strategy for electrode placement at invasive recording, or (b) were confirmatory of other localizing data and did not alter the strategy. We defined that SISCOM had an impact on seizure outcome if the seizure-onset zone was seen in electrodes overlying a brain region with a significant hyperperfusion. When SISCOM was concordant with ictal onset in the extended electrodes, SISCOM was considered a prerequisite for the outcome at postoperative follow-up.Results: SISCOM findings altered and extended the strategy for electrode placement at invasive recording in 15 patients (group A). SISCOM was a prerequisite for seizure outcome in all six patients with favorable outcomes. Nine patients had poor results from surgery in this group; SISCOM was concordant with invasive VEEG in six patients, and discordant with invasive VEEG in three patients. SISCOM findings were confirmatory with other localizing data and did not alter the strategy at invasive recording in five patients (group B). Two patients had favorable surgical outcomes. In this group, three patients had poor results; SISCOM and other localizing findings were concordant with invasive VEEG in one patient and discordant with invasive VEEG in two patients.Conclusions: SISCOM is valuable for the identification of the epileptogenic zone in patients with drug-resistant epilepsy scheduled for invasive VEEG. SISCOM analysis was either a prerequisite for favorable result or concordant with other localizing methods in all patients with favorable seizure outcome at 1 year of follow-up [40%; confidence interval (CI), 19-64). Key Words: Epilepsy-Ictal SPECT-SISCOMSurgical outcome.Epilepsy surgery is successful in ∼70-80% of operatedon patients. The likelihood of seizure freedom is higher if an epileptogenic lesion has been identified on MRI during the presurgical workup (Engel et al., 1993). During the last decade, enhanced diagnostic sensitivity by advances in neuroimaging has reduced the proportion of patients with normal MRIs and has led to a decrease in the need for invasive video-EEG (...

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“…4 Ahnlide et al also reported a case of clinical perisylvian syndrome with normal MRI. 5 Ictal single photon emission computed tomography (SPECT) in this case demonstrated a seizure focus in the perisylvian region suggesting that SPECT together with the clinical data may also be helpful in further understanding this disorder.…”

mentioning

confidence: 78%

Measuring communication outcomes

Pennington

2009

Develop Med Child Neuro

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abnormalities suggesting that functional abnormalities of the perisylvian region could be present. Interestingly, six out of the 20 children with unilateral perisylvian polymicrogyria presented with pseudobulbar palsy despite the unilaterality of their brain malformations. It is likely that these six children also had contralateral perisylvian functional abnormalities. Similarly, we reported four children with unilateral MRI perisylvian abnormalities and diverse clinical manifestations ranging from speech and cognitive delay to intractable epilepsy. Electroencephalography in two of these four patients showed multifocal spike and wave activities involving left and right hemispheres independently. Their 2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET) showed cortical glucose metabolism abnormalities not only in the MRI-detected perisylvian abnormalities but also in the contralateral side (three had contralateral decreases whereas one had contralateral increase in glucose metabolism). The findings suggest that PET may be a useful complementary investigation to MRI in further characterizing the syndrome.4 Ahnlide et al. also reported a case of clinical perisylvian syndrome with normal MRI.5 Ictal single photon emission computed tomography (SPECT) in this case demonstrated a seizure focus in the perisylvian region suggesting that SPECT together with the clinical data may also be helpful in further understanding this disorder.In the Clark et al. paper, the common occurrence of epilepsy in patients with perisylvian polymicrogyria detected on MRI is not surprising since polymicrogyria is known for its epileptogenic nature. An interesting seizure phenotype was also described. Five children presented with profound loss of muscle tone bilaterally associated with apnea and retained consciousness. This type of seizure has not been previously reported in patients with perisylvian polymicrogyria. In this series, there were also patients who developed epileptic encephalopathy. Among these children, four had acquired pseudobulbar palsy related to seizure activity (three CUPP and one CBPP), a finding that has also been reported in a case of acquired epileptic opercular syndrome where the primary seizure focus has been localized in the sylvian fissure. 6 With the overlapping clinical features of congenital perisylvian syndrome and WDS and the presence of clinical features without visible structural imaging abnormalities in the perisylvian region, the authors' proposal to view congenital perisylvian dysfunction as a spectrum with or without MRI abnormalities is reasonable. The authors suggest that the syndrome may be underdiagnosed when there is normal structural imaging. We therefore suggest that if the syndrome is suspected based on clinical features, PET be used as a diagnostic tool in the recognition of the syndrome.

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Ictal SPECT in clinical perisylvian syndrome

Cited by 7 publications

References 5 publications

Transient epileptic opercular syndrome

Transient epileptic opercular syndrome

Does SISCOM Contribute to Favorable Seizure Outcome after Epilepsy Surgery?

Measuring communication outcomes

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