title: [PET and SPECT in epilepsy].
abstract: Epilepsy is one of the most frequent chronic neurological disorders, affecting 1-2% of the population. Patients with complex partial drug resistant episodes may benefit from a surgical treatment consisting in the excision of the epileptogenic area. Localization of the epileptogenic area was classically performed with video-EEG and magnetic resonance (MR). Recently, functional neuroimaging studies of Nuclear Medicine, positron emission tomography (PET) and single photon emission tomography (SPECT) have demonstrated their utility in the localization of the epileptogenic area prior to surgery. Ictal SPECT with brain perfusion tracers show an increase in blood flow in the initial ictal focus, while PET with (18)FDG demonstrates a decrease of glucose metabolism in the interictal functional deficit zone. In this review, the basic principles and methodological characteristics of the SPECT and PET in epilepsy are described. The ictal SPECT injection mechanism, different patterns of perfusion based on the time of ictal, postictal or interictal injection are detailed and the different diagnostic sensitivities of each one of these SPECT are reviewed. Different methods of analysis of the images with substraction and fusion systems with the MR are described. Similarly, the injection methodology, quantification and evaluation of the images of the PET in epilepsy are described. Finally, the main clinical indications of SPECT and PET in temporal and extratemporal epilepsy are detailed.
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínic de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Grupo de imagen biomédica, Barcelona, España. Electronic address: setoain@clinic.ub.es.
authors.forename: X
authors.initials: X
authors.lastname: Setoain
authors.affiliation: Servicio de Neurología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: M
authors.initials: M
authors.lastname: Carreño
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínic de Barcelona, Barcelona, España; Facultad de Medicina, Universitat de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Grupo de imagen biomédica, Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Pavía
authors.affiliation: Facultad de Medicina, Universitat de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Grupo de imagen biomédica, Barcelona, España.
authors.forename: B
authors.initials: B
authors.lastname: Martí-Fuster
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: F
authors.initials: F
authors.lastname: Campos
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínic de Barcelona, Barcelona, España; Facultad de Medicina, Universitat de Barcelona, Barcelona, España.
authors.forename: F
authors.initials: F
authors.lastname: Lomeña
mesh_terms: D004827:Epilepsy / Q000000981:diagnostic imaging*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D059906:Neuroimaging / Q000379:methods*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Epilepsia; Epilepsy; Ictal SPECT; Interictal SPECT; Positron emission tomography; SISCOM; SPECT ictal; SPECT interictal; Tomografía por emisión de positrones