title: Utility of subtraction ictal SPECT when video-EEG fails to distinguish atypical psychogenic and epileptic seizures.
abstract: This study was designed to evaluate the utility of subtraction ictal SPECT coregistered to MRI (SISCOM) in atypical psychogenic nonepileptic seizures (PNES). Video-EEG monitoring (vEEG) is the gold standard for PNES diagnosis but, like any modality, has limitations. In difficult cases in which the diagnosis is suspected but remains in question after vEEG, a complementary study that could help differentiate epilepsy from PNES would be desirable. Thirteen SISCOM studies performed in patients with a final diagnosis of PNES were retrospectively reviewed. Common indications for SISCOM were semiology consistent with partial epilepsy (9/13), abnormal head MRI (5/13), and reported abnormal routine EEG (5/13). SISCOM was negative in 85% (11/13) of patients and was helpful in increasing the diagnostic certainty of PNES in these exceptional cases.
authors.affiliation: New Jersey Neuroscience Institute-JFK Medical Center, Edison, NJ, 08818, USA.
authors.forename: Eli S
authors.initials: ES
authors.lastname: Neiman
authors.forename: Katherine H
authors.initials: KH
authors.lastname: Noe
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Drazkowski
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Sirven
authors.forename: Michael C
authors.initials: MC
authors.lastname: Roarke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001931:Brain Mapping; D003545:Cysteine / Q000031:analogs & derivatives / Q000187:drug effects; D004569:Electroencephalography / Q000379:methods*; D004827:Epilepsy / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010555:Personality Inventory; D011602:Psychophysiologic Disorders / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014741:Video Recording / Q000379:methods*; D055815:Young Adult
chemical_list: D015609:Organotechnetium Compounds; C059659:technetium Tc 99m bicisate; D003545:Cysteine