title: Regional cerebral hyperperfusion with ictal dystonic posturing: ictal-interictal SPECT subtraction.
abstract: 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.
authors.affiliation: Department of Neurology, Samsung Medical Center & Center for Clinical Medicine, SBRI, Sungkyunkwn University School of Medicine, Seoul, Korea.
authors.forename: Eun Yeon
authors.initials: EY
authors.lastname: Joo
authors.forename: Seung Bong
authors.initials: SB
authors.lastname: Hong
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Lee
authors.forename: Woo Suk
authors.initials: WS
authors.lastname: Tae
authors.forename: Jee Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Dae Won
authors.initials: DW
authors.lastname: Seo
authors.forename: Seung Chyul
authors.initials: SC
authors.lastname: Hong
authors.forename: Seunghwan
authors.initials: S
authors.lastname: Kim
authors.forename: Myoung-Hee
authors.initials: MH
authors.lastname: Kim
mesh_terms: 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*
chemical_list: D019275:Radiopharmaceuticals