Regional cerebral hyperperfusion with ictal dystonic posturing: ictal-interictal SPECT subtraction.
OBJECTIVE
Ictal-interictal single-photon emission computed tomography (SPECT) subtraction was performed to find brain structures related to ictal dystonic posturing (DP) in patients with temporal lobe epilepsy (TLE).


METHODS
Thirty-two patients with mesial TLE who had ictal and interictal SPECTs were included. They were divided into two groups; DP group with ictal dystonia during ictal SPECT (n = 15) and Non-DP group without ictal DP (n = 17). Ictal-interictal SPECT subtraction was performed, and then subtracted SPECT was coregistered with brain spoiled gradient recalled (SPGR) magnetic resonance imaging (MRI). The ictal hyperperfusion on subtracted SPECT was analyzed in basal ganglia, frontal cortex, thalamus, temporal lobe, and insular cortex.


RESULTS
The incidences of ictal hyperperfusion on brain regions in DP versus Non-DP groups were 80.0% (12 of 15 patients) versus none (0 of 17), p = 0.001, chi2, in caudate nucleus; 93.3% (14 of 15) versus 47.0% (eight of 17), p = 0.005, in putamen; and 80.0% (12 of 15) versus 41.2% (seven of 17), p = 0.026, in thalamus. No significant difference of ictal hyperperfusion was found in globus pallidus, temporal lobes, insular and frontal cortices between DP and Non-DP groups. DP patients showed an earlier age at seizure onset [8.6 years (DP) vs. 15.7 years (Non-DP) (p = 0.015)] and a longer duration of seizure history [19.0 years (DP) vs. 11.9 years (Non-DP) (p = 0.015)].


CONCLUSIONS
Caudate nucleus, putamen, and thalamus were significantly related to the ictal DP during TLE seizures. Our study showed first an active involvement of the caudate nucleus in the generation of ictal DP.
Joo
Eun Yeon
EY
Department of Neurology, Samsung Medical Center & Center for Clinical Medicine, SBRI, Sungkyunkwn University School of Medicine, Seoul, Korea.
Hong
Seung Bong
SB
Lee
Eun Kyung
EK
Tae
Woo Suk
WS
Kim
Jee Hyun
JH
Seo
Dae Won
DW
Hong
Seung Chyul
SC
Kim
Seunghwan
S
Kim
Myoung-Hee
MH
D001479:Basal Ganglia / Q000098:blood supply / Q000000981:diagnostic imaging / Q000503:physiopathology; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging*; D002421:Caudate Nucleus / Q000098:blood supply / Q000000981:diagnostic imaging / Q000503:physiopathology; D004421:Dystonia / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011699:Putamen / Q000098:blood supply / Q000000981:diagnostic imaging / Q000503:physiopathology; D019275:Radiopharmaceuticals; D012039:Regional Blood Flow / Q000502:physiology; D013382:Subtraction Technique; D013788:Thalamus / Q000098:blood supply / Q000000981:diagnostic imaging / Q000503:physiopathology; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
D019275:Radiopharmaceuticals