Correlation between provoked ictal SPECT and depth recordings in adult drug-resistant epilepsy patients.
OBJECTIVE
To correlate ictal hyperperfusion single-photon emission computed tomography (SPECT) area during provoked seizures to the epileptogenic zone (EZ), as defined by depth recordings in adult drug-resistant patients.


METHODS
We included in the study eight drug-resistant epilepsy patients, subjected to both noninvasive and invasive (stereo-electroencephalography, SEEG) presurgical evaluation in the Epilepsy Surgery Center of the Catholic University in Rome, from 2001 to 2003. All patients were subjected to interictal and provoked ictal SPECT scans during scalp video-EEG monitoring. The ictal hyperperfusion area assessed by visual image analysis and, when possible, by statistical parametric mapping (SPM), was compared with the EZ, as assessed by SEEG, to define whether they colocalized.


RESULTS
For each provoked seizure, we obtained a SPECT hyperperfusion area. In five patients, the SPECT hyperperfusion area was included in the EZ as assessed by SEEG. The effectiveness of provoked SPECT was confirmed by comparison with SEEG data, SPM analysis (four patients), and spontaneous ictal SPECT (two patients). Our data were obtained in adult drug-resistant epilepsy patients whose EZ was either located in or extended to extratemporal regions in all but two patients.


CONCLUSIONS
Provoked ictal SPECT confirmed its efficacy and accuracy in the presurgical evaluation because of the colocalization to the EZ. Although the low number of patients precluded any statistical correlation with the surgical outcome, it is worth pointing out that the five patients in whom the hyperperfusion area was included in the EZ showed very satisfactory results.
Barba
Carmen
C
S. Lucia Foundation, Rome, Italy. carmen.barba@tiscali.it
Di Giuda
Daniela
D
Policicchio
Domenico
D
Bruno
Isabella
I
Papacci
Fabio
F
Colicchio
Gabriella
G
D000328:Adult; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000098:blood supply* / Q000000981:diagnostic imaging; D004351:Drug Resistance; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000379:methods / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008991:Monitoring, Physiologic; D010433:Pentylenetetrazole; D011300:Preoperative Care; D012039:Regional Blood Flow; D013238:Stereotaxic Techniques; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*; D014743:Videotape Recording
D019690:Technetium Tc 99m Exametazime; D010433:Pentylenetetrazole