Differences in ictal hyperperfusion of limbic-related structures between mesial temporal and neocortical epilepsy.
BACKGROUND
Ictal propagation to the cortical and subcortical structures is well known in mesial temporal epilepsy (MTE) and neocortical epilepsy (NE). We analyzed the ictal changes of regional blood flow in limbic-related cortical and subcortical structures to evaluate the differences in ictal propagation patterns between MTE and NE.


METHODS
In 65 patients (mean age, 29.1+/-10.83 years) with intractable MTE (n=46) or NE (n=19), ictal 99m-Tc ethyl cystinate dimer SPECT was performed. A subtracted ictal SPECT coregistered to MRI images was obtained in each patient. The patterns of subtracted ictal hyperperfusion in the limbic, paralimbic and subcortical structures in patients with MTE and NE were compared.


RESULTS
The ictal hyperperfusion of the amygdala, hippocampus, temporal pole and insula were significantly higher in MTE (P<0.01), but cingulate and orbitofrontal hyperperfusion were not. A significant difference in striatal ictal hyperperfusion between the MTE and NE group was found (P=0.035). Ictal hyperperfusion of NE was greater in the superior part (P=0.011), whereas that of MTE was greater in the inferior and middle parts.


CONCLUSIONS
These findings suggest that the ictal propagation of MTE may differ from that of NE via different pathways not only in the cortical regions but also in the subcortical structures.
Kim
Byoung Joon
BJ
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
Hong
Seung Bong
SB
Seo
Dae-Won
DW
D000293:Adolescent; D000328:Adult; D001931:Brain Mapping; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D008032:Limbic System / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D019579:Neocortex / Q000000981:diagnostic imaging*; D019690:Technetium Tc 99m Exametazime; D013702:Temporal Lobe / Q000000981:diagnostic imaging*; D015899:Tomography, Emission-Computed, Single-Photon; D055815:Young Adult
D019690:Technetium Tc 99m Exametazime