Jibiki I, Kido H, Yamaguchi N, Matsuda H, Hisada K
Department of Psychiatry, Kanazawa University School of Medicine, Japan.
Neuropsychobiology. 1993;27(4):204-9. doi: 10.1159/000118982.
Quantitative assessment of regional cerebral blood flow (rCBF) was performed in a 22-year-old man with intractable temporal lobe epilepsy on long-term high-dose phenytoin (PHT) therapy, using single photon emission computed tomography (SPECT) with N-isopropyl-(iodine-123)-p-iodoamphetamine. In all the SPECT scans repeated three times with changes in the PHT dose, absolute rCBF values were lower in most of the cerebral and cerebellar regions measured, as compared with 5 normal subjects matched for sex and age, and 22 normal subjects including the 5 men. Both the cerebellar to frontal rCBF ratio and cerebellar to cerebral rCBF ratio in the patient persistently showed low values, probably reflecting abnormal relative cerebellar hypoperfusion, whereas X-ray computed tomography and magnetic resonance brain imaging showed no abnormal findings. However, this probable cerebellar abnormality on SPECT was to some degree reversible with decreases in the PHT dose. These results suggest the utility of SPECT scans for early detection of cerebellar abnormalities known to be often present in epileptic patients, and imply a risk of long-term high-dose PHT therapy.
采用单光子发射计算机断层扫描（SPECT）技术，以N-异丙基-（碘-123）-对碘安非他明为示踪剂，对一名长期接受大剂量苯妥英（PHT）治疗的22岁难治性颞叶癫痫男性患者进行了局部脑血流量（rCBF）的定量评估。在随着PHT剂量变化重复进行的三次SPECT扫描中，与5名年龄和性别匹配的正常受试者以及包括这5名男性在内的22名正常受试者相比，所测量的大部分脑区和小脑区域的绝对rCBF值均较低。该患者的小脑与额叶rCBF比值以及小脑与全脑rCBF比值持续显示低值，这可能反映了小脑相对灌注不足异常，而X线计算机断层扫描和磁共振脑成像未显示异常结果。然而，随着PHT剂量降低，SPECT上这种可能的小脑异常在一定程度上是可逆的。这些结果表明SPECT扫描有助于早期发现癫痫患者中常见的小脑异常，并提示长期大剂量PHT治疗存在风险。
