Preictal SPECT in Temporal Lobe Epilepsy: Regional Cerebral Blood Flow Is Increased Prior to Electroencephalography-Seizure Onset

• Published in: The Journal of nuclear medicine (1978) Vol. 39; no. 6; pp. 978 - 982
• Main Authors: Baumgartner, Christoph, Serles, Wolfgang, Leutmezer, Fritz, Pataraia, Ekaterina, Aull, Susanne, Czech, Thomas, Pietrzyk, Uwe, Relic, Alessandro, Podreka, Ivo
• Format: Journal Article
• Language: English
• Published: Reston, VA Soc Nuclear Med 01.06.1998; Society of Nuclear Medicine
• Subjects: Adult; Biological and medical sciences; Brain - diagnostic imaging; Cerebrovascular Circulation; Electroencephalography; Epilepsy, Temporal Lobe - diagnostic imaging; Epilepsy, Temporal Lobe - physiopathology; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Medical sciences; Nervous system (semeiology, syndromes); Neurology; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Radionuclide study; Human; Regional blood flow; Nervous system diseases; Pathophysiology; Electrical activity; Complex partial epilepsy; Electroencephalography; Photon; Dynamic conditions; Time variation; Cerebral disorder; Electrodiagnosis; Central nervous system disease; Temporal lobe epilepsy; Hemodynamics; Emission tomography
• ISSN: 0161-5505; 1535-5667

Peri-ictal SPECT provides unique information on the dynamic changes in regional cerebral blood flow (rCBF) that occur during seizure evolution and, thus, could be useful in clarifying the poorly understood interplay of the interictal and ictal states in human focal epilepsy. The regional hyperperfusion observed on ictal SPECT is generally believed to be a consequence of electrical seizure activity. However, recent studies using invasive long-term cortical CBF monitoring have demonstrated that rCBF changes occur up to 20 min prior to ictal electroencephalography (EEG) onset. Because of apparent technical difficulties, no preictal SPECT studies have been reported so far. Therefore, we present our results on two patients with temporal lobe epilepsy in whom preictal SPECT scans were performed fortuitously under continuous video-EEG monitoring control. Technetium-99m-hexamethyl propyleneamine oxime was injected 11 min (Patient 1) and 12 min (Patient 2) before clinical and EEG seizure onset, as documented from simultaneous video-EEG monitoring in two patients with temporal lobe epilepsy. We obtained accurate anatomical reference of CBF changes visible on SPECT by a special coregistration technique of MRI and SPECT. Whereas interictal SPECT showed a hypoperfusion of the temporal lobe ipsilateral to the seizure focus, on preictal SPECT, a significant increase in rCBF in the epileptic temporal lobe could be observed. These rCBF changes were not accompanied by any significant changes of the ongoing EEG. Our study provides evidence that rCBF is increased in the epileptic temporal lobe several minutes before EEG seizure onset. Thus, rCBF changes observed on peri-ictal SPECT scan cannot be considered a mere consequence of EEG seizure activity but may rather reflect a change in neuronal activity precipitating the transition from the interictal to the ictal state.