Lee B I, Lee J D, Kim J Y, Ryu Y H, Kim W J, Lee J H, Lee S J, Park S C
Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
Neurology. 1997 Oct;49(4):981-91. doi: 10.1212/wnl.49.4.981.
The role of single photon emission computed tomography (SPECT) as an independent confirmation test in presurgical evaluation of medically intractable temporal lobe epilepsy has not been critically investigated. Because spreading ictal discharges may cause a concomitant increase of cerebral blood flow in remote cerebral regions, a careful analysis of peri-injection EEG patterns and their relation to ictal SPECT may be important in evaluating the reliability of ictal SPECT. Both interictal and ictal EEG and SPECT were reviewed in 19 patients with temporal lobe epilepsy who achieved a successful seizure outcome after surgery. Patients were divided into unitemporal and bitemporal groups according to the lateralization of interictal epileptiform discharges (IED). Ictal EEG features were classified into lateralized and nonlateralized groups. The concordance between SPECT and EEG lateralizations was examined in each patient and correlated to the documented epileptogenic temporal lobe. Interictal SPECT correctly lateralized in eight of nine patients with unitemporal IED and in five of 10 patients with bitemporal IED. Ictal SPECT was highly concordant with the peri-injection ictal EEG but correctly lateralized the epileptogenic region in only 11 of 19 patients. When both pre- and postinjection EEG epochs lateralized ipsilaterally, all ictal SPECT images showed concordant lateralization. If pre- and postinjection EEG epochs were either different in lateralization or nonlateralization, ictal SPECT images often showed complex patterns of cerebral perfusion with a high incidence of false lateralization. Interictal SPECT was more sensitive and reliable in patients with unitemporal IED than in patients with bitemporal IEDs. Ictal SPECT was closely related with peri-injection EEG epochs but with frequent false lateralization. The role of ictal SPECT as an independent confirmation test in presurgical evaluation should be reappraised.
单光子发射计算机断层扫描（SPECT）在药物难治性颞叶癫痫术前评估中作为独立确认检查的作用尚未得到严格研究。由于发作期放电扩散可能导致远隔脑区脑血流量随之增加，因此仔细分析注射期间脑电图模式及其与发作期SPECT的关系对于评估发作期SPECT的可靠性可能很重要。对19例颞叶癫痫患者进行了术前和术后的脑电图及SPECT检查，这些患者术后癫痫发作得到成功控制。根据发作间期癫痫样放电（IED）的定位将患者分为单颞叶组和双颞叶组。将发作期脑电图特征分为定位组和非定位组。检查每位患者SPECT与脑电图定位之间的一致性，并将其与记录的致痫颞叶相关联。发作间期SPECT在9例单颞叶IED患者中的8例以及10例双颞叶IED患者中的5例中正确定位。发作期SPECT与注射期间的发作期脑电图高度一致，但仅在19例患者中的11例中正确定位了致痫区域。当注射前和注射后脑电图均同侧定位时，所有发作期SPECT图像均显示一致的定位。如果注射前和注射后脑电图在定位或非定位方面不同，发作期SPECT图像通常显示复杂的脑灌注模式，假定位发生率很高。发作间期SPECT在单颞叶IED患者中比在双颞叶IED患者中更敏感和可靠。发作期SPECT与注射期间的脑电图密切相关，但假定位频繁。发作期SPECT在术前评估中作为独立确认检查的作用应重新评估。
