J Korean Epilepsy Soc.
2003 Jun;7(1):16-26.
Regional Cerebral Blood Flow Patterns in Unilateral Mesial Temporal Lobe Epilepsy: Statistical Parametric Mapping of Ictal and Interictal SPECT
- Affiliations
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- 1Neuroimaging Laboratory of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea. sbhong@smc.samsung.co.kr
- 2Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
- 3Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
- 4Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
- 5Department of Computer Science & Engineering, Seoul, Korea.
Abstract
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PURPOSE: To investigate the regional cerebral blood flow of patients with mesial temporal lobe epilepsy (mTLE), we performed the statistical parametric mapping (SPM) analysis in patients with mTLE.
METHODS
Nineteen normal subjects and 38 with mTLE (22 left, 16 right) underwent brain SPECT. For SPM analysis, all SPECT images were spatially normalized and then smoothed. The left and right mTLE groups were statistically compared with normal subjects, and the paired t-test was performed between ictal and interictal SPECTs. The positive and negative contrasts displayed the regions of hypo- or hyper-perfusion, respectively. The significance level was set to false discovery rate corrected p<0.05.
RESULTS
In the interictal state, the ipsilateral hippocampus, both thalami, pericentral gyri, left insula, and both medial frontal lobes showed hypoperfusion, whereas both posterior lateral temporal areas showed hyperperfusion. In the ictal state, the rCBF of ipsilateral temporal lobe to the epileptic focus and both prefrontal white matters increased, while both medial frontal lobes showed hypoperfusion. In the right mTLE, the left hippocampus and insula showed hypoperfusion during the interictal state. In the paired t-test, ipsilateral temporal lobe, hippocampus, thalamus, putamen, insula, and both precentral gyri showed hyperperfusion.
CONCLUSIONS
Surprisingly, the hypoperfusion and hyperperfusion patterns of patients with mTLE were similar both in the interictal and ictal states. These findings indicate that the occurrence and propagation of epileptic discharges happen not only in the ictal state but also during the interictal period. The hypoperfusion patterns suggest that the cortico-thalamo-hippocampal-insula circuit was impaired during the interictal state while temporal and prefrontal regions showed hypofunction during the ictal period.
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