title: [Intercritical SPECT in drug-resistant partial epilepsy with normal MRI: a study of 33 cases].
abstract: We made a prospective study of the intercritical changes in cerebral perfusion using SPECT with 99mTc-HMPAO in 33 adult patients with focal epilepsy which was resistant to polypharmacy and showed normal MR, to evaluate the relationship between these changes and the clinico-electrical focus (FCE) and the clinical features of epilepsy. All SPECT studies (100%) showed one or more areas of hypoperfusion. There was good topographical relationship between the perfusion defects and FCE which coincided exactly in 15 patients (45.4%); was acceptable with FCE identification but with associated defects in 12 (36.4%) and poor, bearing no relation to each other in 6 (18.2%). There was no correlation between a good, acceptable or poor relationship of SPECT-FCE and the age of the patient, time-course of the illness, number of crises, number of drugs or type of treatment given. There were more cases showing poor relationship amongst the pure temporal lobe foci (p < 0.05), but when these were considered together with the fronto-temporal cases, no difference was seen when compared with the extra-temporal cases. There was a tendency to greater secondary generalization of the crises in the group showing a good relationship. There were more cases of a clinical history of previous CNS diffuse lesions (anoxia, trauma or meningitis) amongst those with a poor relationship (83%) but not amongst those with a good relationship (20%, p < 0.05), or an acceptable relationship (25%, p < 0.05). This would seem to suggest that the anomalies found were more a result of the cause of the epilepsy than of the repetition of crises. SPECT should be included in the diagnostic algorithms of focal epilepsy with normal.
authors.affiliation: Servicio de Neurologia, Hospital General de Asturias, Oviedo, España.
authors.forename: J A
authors.initials: JA
authors.lastname: Vidal
authors.forename: J
authors.initials: J
authors.lastname: Salas-Puig
authors.forename: P
authors.initials: P
authors.lastname: Fernández-Raigoso
authors.forename: C
authors.initials: C
authors.lastname: Roiz
authors.forename: J M
authors.initials: JM
authors.lastname: Fernández
authors.forename: A
authors.initials: A
authors.lastname: Suárez-Cuervo
authors.forename: C H
authors.initials: CH
authors.lastname: Lahoz
mesh_terms: D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D001921:Brain / Q000098:blood supply / Q000503:physiopathology; D004351:Drug Resistance; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D000927:Anticonvulsants
vernacular_title: SPECT intercrítica en la epilepsia focal farmacorresistente con RM normal: estudio de 33 casos.