Ictal brain imaging in presurgical evaluation of patients with medically intractable complex partial seizures
Article first published online: 29 JAN 2009
1994 Blackwell Munksgaard
Acta Neurologica Scandinavica
Volume 89, Issue S152, pages 137–144, March 1994
How to Cite
Markand, O. N., Salanova, V., Worth, R. M., Park, H.-M., Wellman, H. H. and Markand, O. N. (1994), Ictal brain imaging in presurgical evaluation of patients with medically intractable complex partial seizures. Acta Neurologica Scandinavica, 89: 137–144. doi: 10.1111/j.1600-0404.1994.tb05206.x
- Issue published online: 29 JAN 2009
- Article first published online: 29 JAN 2009
- ictal SPECT;
- complex partial seizures;
- anterior temporal lobectomy.
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 epilepti-form focus in patients with MI-CPS considered for resective surgery. Both interictal and ictal SPECT need to be performed; combined interictal hypo-perfusion 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.