Dystonic posturing associated with putaminal hyperperfusion depicted on subtraction SPECT.
OBJECTIVE
Dystonic posturing (DP) is one of the most reliable lateralizing indicators for temporal lobe epilepsy (TLE). We evaluated the ictal hyperperfusional areas in patients with DP by using ictal-interictal subtraction single-photon emission computed tomography (SPECT).


METHODS
Ninety-seven patients were treated surgically for intractable TLE, and 39 patients underwent ictal and interictal SPECT studies with the same isotope. These patients were divided into three groups: group I with DP of the contralateral side extended to the epileptogenic focus, group II with elevated muscle tonus but without DP, and group III without DP or alteration of muscle tonus. Ictal, interictal SPECT and thin-slice magnetic resonance imaging (MRI) were overlaid by using the automatic multimodality registration program to construct ictal-interictal subtracted images of SPECT on MRI.


RESULTS
Thirteen patients belonged to group I; 14, to group II; and 12, to group III. A statistically significant difference in hyperperfusion rate was observed in the putamen (10 patients in group I, three in group II and two in group III; p < 0.01) and mesial temporal lobe (10 patients in group I, seven in group II, and two in group III; p < 0.05) on the ipsilateral side of the epileptogenic focus. No statistically significant difference was observed for other ictal symptoms except ipsilateral upper-limb automatism (eight patients in group I, three in group II, and none in group III; p < 0.01).


CONCLUSIONS
A strong correlation between DP and hyperperfusion in the putamen and mesial temporal lobe was demonstrated. Some patients showed a wide hyperperfusion area extending from the mesial temporal lobe to putamen, which may correspond to the propagation of epileptic discharges. Our results suggest a correlation between hyperperfusion of putamen and contralateral dystonic posturing.
Mizobuchi
Masahiro
M
Department of Neurology, Nakamura Memorial Hospital, Sapporo, Japan. mizo@med.nmh.or.jp
Matsuda
Kazumi
K
Inoue
Yushi
Y
Sako
Kazuya
K
Sumi
Yoshihiro
Y
Chitoku
Shiro
S
Tsumaki
Katsumi
K
Takahashi
Masaaki
M
D000293:Adolescent; D000328:Adult; D001931:Brain Mapping; D002648:Child; D004421:Dystonia / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007457:Iodine Radioisotopes; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009129:Muscle Tonus / Q000502:physiology; D011187:Posture / Q000502:physiology*; D011699:Putamen / Q000098:blood supply* / Q000000981:diagnostic imaging*; D013382:Subtraction Technique; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data
D007457:Iodine Radioisotopes; D019690:Technetium Tc 99m Exametazime