Preictal versus ictal injection of radiotracer for SPECT study in partial epilepsy: SISCOM.
A 27-year-old man had complex partial seizures and a dysembryoplastic neuroepithelial tumor (DNT) in the left inferior-basal temporal region. The patient's seizures consisted of incomprehensible speech, staring, unresponsiveness, fumbling and then looking around. For the brain SPECT study, radiotracer was injected during the preictal (11s prior to seizure onset), ictal (at 25 s out of 47 s seizure duration) and interictal periods. Interictal SPECT was subtracted from preictal or ictal-injection SPECTs and then the subtracted SPECTs were overlaid on the patient's MRI (SISCOM). SISCOM with preictal-injection SPECT showed hyperperfusion at the brain lesion, whereas SISCOM with ictal-injection SPECT showed hyperperfusion at the ipsilateral amygdala-hippocampus and hypoperfusion around the tumor lesion. After the DNT and nearby temporal lobe tissues were resected with preservation of amygdala-hippocampus, the patient became seizure free without complaint of subjective postsurgical memory decline. In this patient, SISCOM with preictal injection of radiotracer localized an epileptogenic zone, whereas SISCOM with the ictal injection showed hyperperfusion at the symptomatogenic zone.
Hong
Seung Bong
SB
Department of Neurology, Samsung Medical Center, SBRI, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea. seungbong.hong@samsung.com
Joo
Eun Yeon
EY
Tae
Woo Suk
WS
Cho
Jae-Wook
JW
Lee
Ji-Hyun
JH
Seo
Dae Won
DW
Suh
Yeon-Lim
YL
Hong
Seung Chyul
SC
D000328:Adult; D001932:Brain Neoplasms / Q000150:complications / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation / Q000502:physiology; D003545:Cysteine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004828:Epilepsies, Partial / Q000000981:diagnostic imaging* / Q000209:etiology / Q000523:psychology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D018302:Neoplasms, Neuroepithelial / Q000150:complications / Q000000981:diagnostic imaging; D015609:Organotechnetium Compounds / Q000008:administration & dosage; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D012640:Seizures / Q000000981:diagnostic imaging* / Q000209:etiology / Q000523:psychology; D015899:Tomography, Emission-Computed, Single-Photon
D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C059659:technetium Tc 99m bicisate; D003545:Cysteine