Pediatric Neurology Unit, Children's Hospital "A. Meyer", viale Pieraccini 24, 50139 Florence, Italy.
J Neurol. 2012 Aug;259(8):1613-22. doi: 10.1007/s00415-011-6387-0. Epub 2012 Jan 25.
Brain single photon emission computed tomography (SPECT) can be a useful tool to identify the epileptogenic zone in selected patients. However, ictal SPECT during spontaneous seizures is difficult to obtain and can be expensive, due to extra hospitalization time and personnel resource utilization. The efficacy of ictal SPECT depends on the ability to inject as early as possible after the beginning of the ictal discharge and/or the occurrence of the first symptom and is challenged by the short duration and rapid propagation of seizures, especially extratemporal seizures. We studied 52 patients with drug-resistant epilepsy who underwent ictal SPECT during provoked seizures in order to demonstrate the efficacy of this technique to define the epileptogenic zone and its predictive value on surgical outcome 2 and 5 years after surgery. In our study, SPECT hyperperfusion areas and electroclinical findings co-localized within the same lobe in 40 patients. Thirty-one patients were operated; at the 2-year follow-up 25 of these patients were in Engel's class I. Eighteen of the seizure-free patients showed a co-localization between the provoked SPECT hyperperfusion areas and the epileptogenic zones. Eighteen of the 31 operated patients were followed 5 years after surgery. The surgical outcome was stable in all but one subject. All the patients who were seizure-free at the 5-year follow-up showed a co-localization between the provoked SPECT hyperperfusion areas and the epileptogenic zones. Ictal SPECT demonstrated additional diagnostic value in the identification of the epileptogenic zone in 20 patients: 11 extratemporal (4 probably symptomatic and 7 lesional), 1 temporal plus (probably symptomatic), and 8 temporal (1 probably symptomatic and 7 lesional). Statistical analysis showed a significant association between the concordance of SPECT hyperperfusion areas to epileptogenic zones and freedom from seizures as assessed 5 years after surgery.
脑单光子发射计算机断层扫描（SPECT）可以成为识别选定患者致痫区的有用工具。然而，在自发性癫痫发作期间进行发作期 SPECT 比较困难，因为需要额外的住院时间和人员资源，而且费用昂贵。发作期 SPECT 的效果取决于在发作放电开始后尽早注射的能力和/或出现第一个症状的能力，而癫痫发作的持续时间短且传播迅速，特别是颞叶外癫痫发作，这对其效果构成了挑战。我们研究了 52 例药物难治性癫痫患者，他们在诱发性癫痫发作期间进行了发作期 SPECT，以证明该技术定义致痫区的效果及其对术后 2 年和 5 年手术结果的预测价值。在我们的研究中，SPECT 高灌注区域和电临床发现与同叶内的同一位置相吻合，40 例患者中存在这种情况。31 例患者接受了手术；在 2 年的随访中，25 例患者达到了 Engel Ⅰ级。18 例无癫痫发作的患者中，诱发性 SPECT 高灌注区域与致痫区之间存在重合。31 例接受手术的患者中有 18 例在术后 5 年进行了随访。除了 1 例患者外，其余患者的手术效果都稳定。所有在术后 5 年随访时无癫痫发作的患者中，诱发性 SPECT 高灌注区域与致痫区之间存在重合。在 20 例患者中，发作期 SPECT 显示了额外的诊断价值：11 例颞叶外（4 例可能症状性，7 例病变性），1 例颞叶加（可能症状性）和 8 例颞叶（1 例可能症状性，7 例病变性）。统计分析显示，SPECT 高灌注区域与致痫区的一致性与术后 5 年无癫痫发作之间存在显著相关性。
