title: SPECT-PET in Epilepsy and Clinical Approach in Evaluation.
abstract: In epilepsy, a detailed history, blood chemistry, routine electroencephalography, and brain MRI are important for the diagnosis of seizure type or epilepsy syndrome for the decision of appropriate drug treatment. Although antiepileptic drugs are mostly successful for controlling epileptic seizures, 20%-30% patients are resistant to medical treatment and continue to have seizures. In this intractable patient group, surgical resection is the primarily preferred treatment option. This particular group of patients should be referred to the epilepsy center for detailed investigation and further treatment. When the results of electroencephalography, MRI, and clinical status are discordant or there is no structural lesion on MRI, ictal-periictal SPECT, and interictal PET play key roles for lateralization or localization of epileptic region and guidance for the subsequent subdural electrode placement in intractable epilepsy. SPECT and PET show the functional status of the brain. SPECT and PET play important roles in the evaluation of epilepsy sydromes in childhood by showing abnormal brain regions. Most of the experience has been gained with (18)FDG-PET, in this respect. (11)C-flumazenil-PET usually deliniates the seizure focus more smaller than (18)FDG-PET and is sensitive in identifying medial temporal sclerosis. (11)C-alpha-methyl-l-tryptophan is helpful in the differentiation of epileptogenic and nonepileptogenic regions in children especially in tuberous sclerosis and multifocal cortical dysplasia for the evaluation of surgery. Finally, when there is concordance among these detailed investigations, resective surgery or palliative procedures can be discussed individually.
authors.affiliation: Department of Nuclear Medicine, Hacettepe University, Medical School, Ankara, Turkey. Electronic address: eergul@hacettepe.edu.tr.
authors.forename: Eser Lay
authors.initials: EL
authors.lastname: Ergün
authors.affiliation: Department of Neurology, Hacettepe University, Medical School, Ankara, Turkey.
authors.forename: Serap
authors.initials: S
authors.lastname: Saygi
authors.affiliation: Department of Pediatric Neurology, Hacettepe University, Medical School, Ankara, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Yalnizoglu
authors.affiliation: Department of Diagnostic Radiology, Hacettepe University, Medical School, Ankara, Turkey.
authors.forename: Kader Karli
authors.initials: KK
authors.lastname: Oguz
authors.affiliation: Department of Nuclear Medicine, Hacettepe University, Medical School, Ankara, Turkey.
authors.forename: Belkis
authors.initials: B
authors.lastname: Erbas
mesh_terms: D004827:Epilepsy / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy; D006801:Humans; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*