Utility of ictal single photon emission computed tomography in mesial temporal lobe epilepsy with hippocampal atrophy: a randomized trial.
BACKGROUND
The development of newer diagnostic technologies has reduced the need for invasive electroencephalographic (EEG) studies in identifying the epileptogenic zone, especially in adult patients with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS).


OBJECTIVE
To evaluate ictal single photon emission computed tomography (SPECT) in the evaluation and treatment of patients with MTLE-HS.


METHODS
MTLE patients were randomly assigned to those with (SPECT, n = 124) and without ictal SPECT (non-SPECT, n = 116) in an intent-to-treat protocol. Primary end points were the proportion of patients with invasive EEG studies, and those offered surgery. Secondary end points were the length of hospital stay and the proportion of patients with secondarily generalized seizures (SGS) during video-EEG, postsurgical seizure outcome, and hospital cost.


RESULTS
The proportion of patients offered surgery was similar in the SPECT (85%) and non-SPECT groups (81%), as well as the proportion that had invasive EEG studies (27% vs 23%). The mean duration of hospital stay was 1 day longer for the SPECT group (P < 0.001). SGS occurred in 51% of the SPECT and 26% of the non-SPECT group (P < 0.001). The cost of the presurgical evaluation was 35% higher for the SPECT compared with the non-SPECT group (P < 0.001). The proportion of patients seizure-free after surgery was similar in the SPECT (59%) compared with non-SPECT group (54%).


CONCLUSIONS
Ictal-SPECT did not add localizing value beyond what was provided by EEG-video telemetry and structural MRI that altered the surgical decision and outcome for MTLE-HS patients. Ictal-SPECT increased hospital stay was associated with increased costs and a higher chance of SGS during video-EEG monitoring. These findings support the notion that a protocol including ictal SPECT is equivalent to one without SPECT in the presurgical evaluation of adult patients with MTLE-HS.
Department of Neurology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirao Preto, Brazil. tonicarlo@gmail.com
Tonicarlo R
TR
Velasco
Lauro
L
Wichert-Ana
Gary W
GW
Mathern
David
D
Araújo
Roger
R
Walz
Marino M
MM
Bianchin
Charles L
CL
Dalmagro
Joao P
JP
Leite
Antonio C
AC
Santos
Joao A
JA
Assirati
Carlos G
CG
Carlotti
Americo C
AC
Sakamoto
D000328:Adult; D001284:Atrophy; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D005260:Female; D006624:Hippocampus / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D012598:Sclerosis / Q000000981:diagnostic imaging / Q000473:pathology; D015899:Tomography, Emission-Computed, Single-Photon