title: The clinical usefulness of ictal SPECT in temporal lobe epilepsy: the lateralization of seizure focus and correlation with EEG.
abstract: OBJECTIVE
  To analyze the relationship between ictal electroencephalography (EEG) and ictal single-photon emission computed tomography (SPECT) and to evaluate the diagnostic usefulness of ictal SPECT as an independent presurgical evaluation technique.
  
  
  METHODS
  Sixty-eight patients with temporal lobe epilepsy who underwent temporal lobectomy with good surgical outcome were included in this study. Ictal SPECT was performed during video-EEG monitoring. The ictal EEG was analyzed in 5-second intervals from the initiation of the ictal rhythm. Lateralized EEG dominance was determined by the amplitude, frequency, or regional patterns of ictal rhythm for each 5-second interval. The total ictal EEG was divided into three periods: preinjection (maximum, 30 seconds), the initial part of the postinjection period (30 seconds), and the latter part of the postinjection period (30 to 60 seconds). The results of ictal SPECT were compared with the lateralized EEG dominance of each period and at seizure onset.
  
  
  RESULTS
  Fifty-four of 68 ictal EEGs correctly lateralized seizure focus ipsilateral to the side of surgery. Ictal SPECT correctly lateralized the epileptogenic temporal lobe in 61 of 68 patients (mean injection time, 29.8 seconds from onset). Multivariate analysis indicated that only the EEG dominance of the preejection period correlated significantly with the concordant hyperperfusion of ictal SPECT. Correct lateralization of ictal SPECT occurred in 10 of 14 patients with nonlateralized ictal EEG.
  
  
  CONCLUSIONS
  Preinjection neuronal activity seems to be important for the accurate interpretation of the hyperperfused patterns of ictal SPECT. Ictal SPECT is an independent and confirmatory presurgical evaluation technique.
authors.affiliation: Department of Neurology, Graduate School of Public Health, Seoul National University College of Medicine, Korea. sangunlee@medicine.snu.ac.kr
authors.forename: S K
authors.initials: SK
authors.lastname: Lee
authors.forename: S H
authors.initials: SH
authors.lastname: Lee
authors.forename: S K
authors.initials: SK
authors.lastname: Kim
authors.forename: D S
authors.initials: DS
authors.lastname: Lee
authors.forename: H
authors.initials: H
authors.lastname: Kim
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation; D004569:Electroencephalography / Q000706:statistics & numerical data*; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D005500:Follow-Up Studies; D007839:Functional Laterality; D006801:Humans; D008991:Monitoring, Physiologic; D015999:Multivariate Analysis; D019690:Technetium Tc 99m Exametazime; D013702:Temporal Lobe / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D015899:Tomography, Emission-Computed, Single-Photon; D014743:Videotape Recording
chemical_list: D019690:Technetium Tc 99m Exametazime