J Korean Neurol Assoc.  1998 Feb;16(1):28-35.

SPECT and PET for the Localization of Seizure Foci in Localization-Related Epilepsy

Affiliations
  • 1Department of Nuclear Medicine, Sung Kyun Kwan University College of Medicine, Samsung Medical Center, Seoul, Korea.
  • 2Department of Neurology, Sung Kyun Kwan University College of Medicine, Samsung Medical Center, Seoul, Korea.
  • 3Department of Neurosurgery, Sung Kyun Kwan University College of Medicine, Samsung Medical Center, Seoul, Korea.
  • 4Department of Diagnostic Radiology, Sung Kyun Kwan University College of Medicine, Samsung Medical Center, Seoul, Korea.

Abstract

The efficacy of 99mTc-ECD SPECT, [18F]FDG PET, and MRI for the localization of seizure foci was evaluated in 110 patients with partial epilepsy [77 with temporal lobe epilepsy (TLE); 33 with extratemporal lobe epilepsy (ETLE)]. Two standards were employed for the determination of seizure foci: 1) clinico-electrical data and 2) postoperative outcome. In 77 patients with TLE, the sensitivities of interictal and ictal SPECT, [18F]FDG PET, and MRI for the localization of seizure foci were 63%, 90%, 87%, and 80%, respectively. PET localized seizure foci correctly in 75% of TLE patients with normal or nonlocalizing MRI while seizure foci were localized correctly by MRI in 60% of TLE patients with nonlocalizing PET. In 33 TLE patients with good surgical outcome (Engel classes I, II) and greater than one year follow-up, the sensitivities of interictal and ictal SPECT, PET, and MRI were 46%, 100%, 88%, and 82%, respectively. The frequency of extratemporal hypometabolism on preoperative PET was significantly higher in TLE patients with Engel classes IB-IV than in TLE patients with Engel class IA(5/19 vs 14/17, p<0.001). In 33 patients with ETLE, the sensitivities of the neuroimaging studies for the localization of seizure foci were lower: ictal SPECT, 57%; interictal SPECT, 35%; PET, 36%; and MRI, 21%. In 9 ETLE patients with good surgical outcome and greater than one year follow-up, the sensitivities of interictal and ictal SPECT, PET, and MRI were 43%, 50%, 22%, and 33%, respectively. The data demonstrate that ictal perfusion SPECT and [18F]FDG PET may be useful for the localization of seizure foci in TLE. Additionally, the presence of extratemporal hypometabolism in TLE might indicate an unfavorable surgical outcome.

Keyword

epilepsy; single photon emission computed tomography; positron emission tomography

MeSH Terms

Epilepsies, Partial*
Epilepsy
Epilepsy, Temporal Lobe
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Neuroimaging
Perfusion
Positron-Emission Tomography
Seizures*
Tomography, Emission-Computed, Single-Photon*
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