Departments of Nuclear Medicine.
Neurology.
Nucl Med Commun. 2020 Sep;41(9):858-870. doi: 10.1097/MNM.0000000000001240.
Localization of epileptogenic focus in drug-refractory epilepsy using Tc-99m ethylene cystine dimer (ECD) brain single photon emission computed tomography (SPECT) is less studied in patients with discordant findings on video electroencephalogram (VEEG) and MRI. The study was done to evaluate brain SPECT for epileptogenic focus localization and postoperative seizure freedom.
Epilepsy patients with discordant VEEG and MRI findings underwent brain SPECT at ictal and interictal phases. Various groups unilateral/bilateral mesial temporal sclerosis (MTS), solitary and multifocal lesional, nonlesional epilepsy were studied for localization of epileptogenic focus and postoperative seizure freedom (>2 years) using Engels classification. Reasons for nonoperability was evaluated in nonoperated group.
SPECT could localize epileptogenic focus in 49/67 (73.13%) and guided surgery in 19/33 (57.57%) patients in operated group. SPECT was useful in 12 (46.12%) of unilateral (2)/bilateral (10) MTS. Postoperative seizure freedom of Engels Class I and II in 22 (66.67%), III in six (18.2%) and IV in one patient based on SPECT findings (P = 0.0086). Overall sensitivity and specificity were 79.3% and 85.7%, respectively. SPECT could localize epileptogenic focus in 23/34 (67.64%) patients in nonoperated group; 10 (29.41%) patients refused for surgery and no epileptogenic focus was localized in the rest of 14 (41.2%).
Ictal SPECT showed incremental value and was found necessary for epileptogenic focus localization and subsequent surgery in unilateral/bilateral MTS in this study. Seizure freedom in patients undergoing epilepsy surgery based on ictal SPECT assistance was comparable to the surgical group not requiring ictal SPECT.
在视频脑电图（VEEG）和 MRI 结果不一致的耐药性癫痫患者中，使用 Tc-99m 乙撑双半胱氨酸二聚体（ECD）脑单光子发射计算机断层扫描（SPECT）对致痫灶进行定位的研究较少。本研究旨在评估脑 SPECT 对致痫灶定位和术后无癫痫发作的作用。
对 VEEG 和 MRI 结果不一致的癫痫患者进行发作期和发作间期脑 SPECT 检查。根据恩格尔斯（Engels）分类，研究单侧/双侧内侧颞叶硬化症（MTS）、单发和多发局灶性病变、非局灶性病变癫痫患者的致痫灶定位和术后 2 年以上的无癫痫发作（Engels Ⅰ级和Ⅱ级）。在未手术组中，评估了不可手术的原因。
在手术组中，SPECT 可以定位 49/67（73.13%）例患者的致痫灶，并指导其中 19/33（57.57%）例患者进行手术。SPECT 在 12 例单侧（2 例）/双侧（10 例）MTS 中有用。根据 SPECT 结果，Engels Ⅰ级和Ⅱ级的术后无癫痫发作率为 22 例（66.67%），Ⅲ级为 6 例（18.2%），Ⅳ级为 1 例（3.03%）（P=0.0086）。总的敏感性和特异性分别为 79.3%和 85.7%。在未手术组中，SPECT 可以定位 23/34（67.64%）例患者的致痫灶；10 例（29.41%）患者拒绝手术，其余 14 例（41.2%）患者未能定位致痫灶。
本研究表明，发作期 SPECT 具有附加价值，对于单侧/双侧 MTS 患者的致痫灶定位和随后的手术是必要的。基于发作期 SPECT 辅助的癫痫手术患者的无癫痫发作率与无需发作期 SPECT 的手术组相当。
