Faculty of Medicine, University of Sydney, NSW, Australia.
Epilepsia. 2010 Oct;51(10):2131-9. doi: 10.1111/j.1528-1167.2010.02723.x.
Patients who have seizure onset from different brain regions can produce seizures that appear clinically indistinguishable from one another. These clinically stereotypic manifestations reflect epileptic activation of specific networks. Several studies have shown that ictal perfusion single photon emission computed tomography (SPECT) can reveal propagated ictal activity. We hypothesize that the pattern of hyperperfusion may reflect neuronal networks that generated specific ictal symptomatology.
All patients were identified who were injected with (99m)Tc-hexamethyl-propylene-amine-oxime (HMPAO) during versive seizures (n = 5), bilateral asymmetric tonic seizures (BATS; n = 5), and hypermotor seizures (n = 7) in the presurgical epilepsy evaluation between 2001 and 2005. The SPECT ictal–interictal difference image pairs of each subgroup were compared with image pairs of 14 controls using statistical parametric mapping (SPM 2) to identify regions of significant hyperperfusion. Hyperperfused regions with corrected cluster-level significance p < 0.05 were considered significant.
We have identified a distinct ictal perfusion pattern in each subgroup. In versive seizure subgroup, prominent hyperperfusion was present in the frontal eye field opposite to the direction of head version. In addition, there was associated caudate and crossed cerebellar hyperperfusion. The BATS subgroup showed pronounced hyperperfusion supplementary sensorimotor area ipsilateral to the epileptogenic region, bilateral basal ganglia, and contralateral cerebellar hemisphere. The hypermotor seizure subgroup demonstrated two clusters of significant hyperperfusion: one involving bilateral frontomesial regions, cingulate gyri, and caudate nuclei, and another involving ipsilateral anteromesial temporal structures, frontoorbital region, insula, and basal ganglia.
We have identified distinct hyperperfusion patterns for specific ictal symptomatology. Our findings provide further insight into understanding the anatomic basis of seizure semiology.
起源于不同脑区的癫痫患者可产生临床表现难以区分的癫痫发作。这些具有临床特征的表现反映了特定网络的癫痫激活。几项研究表明，发作期灌注单光子发射计算机断层扫描（SPECT）可以揭示传播性癫痫发作活动。我们假设，过度灌注的模式可能反映了产生特定癫痫症状的神经元网络。
在 2001 年至 2005 年的术前癫痫评估中，我们确定了在扭转性发作（n=5）、双侧不对称强直发作（BATS；n=5）和运动性发作（n=7）期间注射（99m）Tc-六甲基丙烯胺肟（HMPAO）的所有患者。使用统计参数映射（SPM 2）对每个亚组的 SPECT 发作期-发作间期差异图像对与 14 个对照的图像对进行比较，以识别显著过度灌注的区域。校正簇级显著 p<0.05 的过度灌注区域被认为具有统计学意义。
我们在每个亚组中都确定了一种独特的发作期灌注模式。在扭转性发作亚组中，与头部扭转方向相反的额眼区存在明显的过度灌注。此外，还存在尾状核和交叉小脑的过度灌注。BATS 亚组表现为对侧基底节和对侧小脑半球同侧癫痫灶的补充感觉运动区显著过度灌注。运动性发作亚组表现为两个显著过度灌注簇：一个涉及双侧额内侧区域、扣带回和尾状核，另一个涉及同侧前内侧颞叶结构、额眶区、岛叶和基底节。
我们已经确定了特定癫痫症状的独特过度灌注模式。我们的发现进一步深入了解了癫痫发作症状的解剖学基础。
