Rowe C C, Berkovic S F, Sia S T, Austin M, McKay W J, Kalnins R M, Bladin P F
Department of Neurology, Austin Hospital, Heidelberg, Victoria, Australia.
Ann Neurol. 1989 Nov;26(5):660-8. doi: 10.1002/ana.410260512.
Effective surgical treatment of patients with intractable complex partial seizures depends on accurate preoperative seizure focus localization. We evaluated seizure localization with interictal and immediate postictal single photon emission computed tomographic images of cerebral perfusion using technetium-99m-hexamethyl-propyleneamineoxime (99mTc-HMPAO) in comparison with conventional ictal electroencephalographic (EEG) localization. Thirty-two patients with intractable complex partial seizures were studied. The mean delay from seizure onset to injection was 6.3 +/- 5.3 (SD) minutes. Independent blinded observers assessed the scans for interictal hypoperfusion and postictal focal hyperperfusion. Interictal scans alone were unreliable, indicating the correct localization in 17 patients (53%) and an incorrect site in 3 (9%). When interictal and postictal scans were interpreted together, the focus was correctly localized in 23 patients (72%). There was 1 false-positive study, and 8 patients had inconclusive changes, including 2 with inconclusive depth EEG studies. Postictal hyperperfusion was predominantly mesial temporal and frequently associated with hypoperfusion of lateral temporal cortex. Secondarily generalized seizures tended to show focal hyperperfusion less often than complex partial seizures did (Fisher's exact test p = 0.09). Combined interictal and immediate postictal single photon emission computed tomography with 99mTc-HMPAO is a useful noninvasive technique for independent confirmation of electrographic seizure localization. It may provide a suitable alternative to the use of depth electrode studies for confirmation of surface EEG findings in many patients with complex partial seizures.
对难治性复杂部分性癫痫患者进行有效的手术治疗取决于术前准确的癫痫病灶定位。我们使用锝-99m-六甲基丙烯胺肟（99mTc-HMPAO），通过发作间期和发作后即刻的脑灌注单光子发射计算机断层扫描图像评估癫痫病灶定位，并与传统的发作期脑电图（EEG）定位进行比较。研究了32例难治性复杂部分性癫痫患者。从癫痫发作开始到注射的平均延迟时间为6.3±5.3（标准差）分钟。独立的盲法观察者评估扫描图像，以确定发作间期灌注减低和发作后局部灌注增加情况。仅发作间期扫描不可靠，在17例患者（53%）中指示了正确的定位，在3例患者（9%）中指示了错误的部位。当将发作间期和发作后扫描结果一起解读时，23例患者（72%）的病灶被正确定位。有1例假阳性研究，8例患者有不确定的变化，包括2例深度脑电图研究结果不确定的患者。发作后灌注增加主要位于颞叶内侧，且常与颞叶外侧皮质灌注减低相关。继发性全身性癫痫发作比复杂部分性癫痫发作较少出现局部灌注增加（Fisher精确检验p = 0.09）。99mTc-HMPAO联合发作间期和发作后即刻单光子发射计算机断层扫描是一种有用的非侵入性技术，可独立确认脑电图癫痫病灶定位。对于许多复杂部分性癫痫患者，它可能是一种合适的替代方法，可用于替代深度电极研究以确认头皮脑电图结果。
