title: Developing an effective program to complete ictal SPECT in the epilepsy monitoring unit.
abstract: With the availability of more stable radiopharmaceuticals, the ictal single photon emission computed tomography (SPECT) perfusion study has emerged as a useful noninvasive functional neuroimaging tool in the presurgical evaluation of patients with medically intractable partial epilepsy. The purpose of this study was to determine whether the development of a program using trained electroencephalography (EEG) technologists to perform ictal injections in the epilepsy monitoring unit enabled a more efficient delivery of radiopharmaceuticals and therefore a higher specificity and sensitivity of outcome. All patients admitted to the epilepsy monitoring unit for prolonged video/EEG monitoring as part of the presurgical evaluation were eligible for completion of an ictal SPECT study using a three-way needle-free apparatus. Over a 19-month period, 85 (77%)) of 110 eligible patients were successfully injected during typical partial seizures. Various factors were analyzed including latency of ictal injection (27.3+/-20.8 [S.D.] s), radiopharmaceutical wastage (40% dose utilization), radiation safety parameters (1.6% contamination rate), and preliminary data of localizing value. Our results show that ictal SPECT can be a safe, noninvasive procedure completed on a routine basis in the epilepsy monitoring unit when appropriately trained support staff are utilized as part of a structured multidisciplinary program.
authors: Department of Neurology, Surgical Epilepsy Program, Henry Ford Hospital, Detroit, MI 48202, USA.
authors: B J
authors: BJ
authors: Smith
authors: K C
authors: KC
authors: Karvelis
authors: S
authors: S
authors: Cronan
authors: W
authors: W
authors: Porter
authors: L
authors: L
authors: Smith
authors: M V
authors: MV
authors: Pantelic
authors: K
authors: K
authors: Elisevich
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002648:Child; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D007267:Injections; D008991:Monitoring, Physiologic; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D012449:Safety; D012680:Sensitivity and Specificity; D013690:Television; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals