title: Ictal chronology and interictal spikes predict perfusion patterns in temporal lobe epilepsy: a multivariate study.
abstract: Typical (TPP) and atypical (APP) perfusion patterns (PP) may be seen in ictal SPECT of patients with temporal lobe epilepsy (TLE). APP may pose problem in the lateralization of the epileptogenic zone (EZ). We aimed to investigate predictive variables for the occurrence of TPP and APP. Fifty-one TLE patients were submitted to successful anterior-mesial temporal lobectomy. Univariate (UVA) and multivariate (MVA) analysis were performed upon clinical data, distribution of interictal spikes, and ictal chronology of seizures. From MVA, a final predictive model (FPM) was determined to better predict TPP and APP. Forty patients showed TPP (78.5%) and 11 patients APP (21.5%). Accuracy of ictal SPECT was higher in the unilateral (UIS) than in the bilateral (BIS) interictal spikes group (P = 0.05). FPM showed that patients exhibiting BIS, with shorter proportion of the electrographic seizure occurring after completion of tracer injection, and longer clinical than EEG seizure duration had more APP (P = 0.003). Generalized tonic-clonic seizures did not result in more APP. We concluded that analysis of ictal SPECT in TLE requires the knowledge of TPP and APP, the distribution of interictal spikes on temporal lobes and the ictal chronology of seizures. BIS showed that beyond a more complex epileptogenicity and seizure propagation, they may also lead to APP.
authors.affiliation: Department of Neurology, Epilepsy Surgery Center (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil. lwichert@rnp.fmrp.usp.br
authors.forename: Lauro
authors.initials: L
authors.lastname: Wichert-Ana
authors.forename: Tonicarlo Rodrigues
authors.initials: TR
authors.lastname: Velasco
authors.forename: Vera Cristina
authors.initials: VC
authors.lastname: Terra-Bustamante
authors.forename: Veriano
authors.initials: V
authors.lastname: Alexandre
authors.forename: Ricardo
authors.initials: R
authors.lastname: Guarnieri
authors.forename: Roger
authors.initials: R
authors.lastname: Walz
authors.forename: Mery
authors.initials: M
authors.lastname: Kato
authors.forename: Whemberton Martins
authors.initials: WM
authors.lastname: Araújo
authors.forename: Carlos Gilberto
authors.initials: CG
authors.lastname: Carlotti
authors.forename: David
authors.initials: D
authors.lastname: Araújo
authors.forename: Antonio
authors.initials: A
authors.lastname: Carlos Dos Santos
authors.forename: Américo Ceiki
authors.initials: AC
authors.lastname: Sakamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D019690:Technetium Tc 99m Exametazime; D013702:Temporal Lobe / Q000503:physiopathology*; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime