Ictal chronology and interictal spikes predict perfusion patterns in temporal lobe epilepsy: a multivariate study.
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.
Wichert-Ana
Lauro
L
Department of Neurology, Epilepsy Surgery Center (CIREP), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil. lwichert@rnp.fmrp.usp.br
Velasco
Tonicarlo Rodrigues
TR
Terra-Bustamante
Vera Cristina
VC
Alexandre
Veriano
V
Guarnieri
Ricardo
R
Walz
Roger
R
Kato
Mery
M
Araújo
Whemberton Martins
WM
Carlotti
Carlos Gilberto
CG
Araújo
David
D
Carlos Dos Santos
Antonio
A
Sakamoto
Américo Ceiki
AC
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
D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime