[Cerebral SPECT in partial epilepsy].
Effective surgical treatment of patients with medically intractable complex partial seizures depends on accurate preoperative localization of the seizure focus. 99mTc-HMPAO brain SPECT could assist us in localizing the epileptic foci showing focal hypoperfusion on interictal SPECT and hyperperfusion on ictal SPECT.


METHODS
Video-EEG monitoring, MRI, as well as interictal and peri-ictal brain SPECT were performed on 37 patients with refractory epilepsy. Ictal brain SPECT was performed on 14 patients and in the remaining 23 patients a postictal SPECT was obtained. Video-EEG was used as the gold standard procedure for localizing the seizure focus and was compared to the interictal and peri-ictal brain SPECT results. Twenty-four patients suffered from temporal lobe epilepsy and 13 had extratemporal seizures.


RESULTS
Interictal brain SPECT correctly localized the seizure focus in 43% of the patients (58.3% of the patients with temporal lobe seizures and 15.4% of the patients with extratemporal seizures). Ictal SPECT correctly identified the seizure focus in the 93% of cases (100% of the patients with temporal lobe seizures and 75% of the patients with extratemporal seizures). Finally, 52% of the patients were correctly identified with postictal SPECT (71.4% of the patients with temporal lobe seizures and 22.2% of the patients with extratemporal seizures).


CONCLUSIONS
Our findings suggest that interictal brain SPECT could assist in the localization of temporal lobe seizures. Tracer injection during seizure or immediately after it (peri-ictal SPECT) is the method of choice for SPECT imaging aimed at the non-invasive localization of seizure focus.
Servicio de Medicina Nuclear, Hospital Clínic i Provincial de Barcelona, Barcelona, 08036, España.
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Setoain
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Lomeña
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Arroyo
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D
Fuster
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Pavía
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A
Catafau
J
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Rumiá
J
J
Setoian
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000503:physiopathology; D015899:Tomography, Emission-Computed, Single-Photon