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Neurology 2000;55:835-841
© 2000 American Academy of Neurology
Articles

Late postictal residual perfusion abnormality in epileptogenic zone found on 6-hour postictal SPECT

D. S. Lee, MD, S. K. Lee, MD, S.-K. Kim, MD, K. W. Kang, MD, E. Kang, PhD, K. H. Lee, MD, I. Y. Hyun, MD, J.-K. Chung, MD and M. C. Lee, MD

From the Institute of Radiation Medicine, Seoul National University Medical Research Center (Drs. D.-S. Lee, Kim, K.-W. Kang, E. Kang, K.-H. Lee, Hyun, Chung, and M.-C. Lee), and Departments of Nuclear Medicine (Drs. D.-S. Lee, K.-W. Kang, Chung, and M.-C. Lee) and Neurology (Dr. S.-K. Lee), Seoul National University College of Medicine, Seoul, Korea.

Address correspondence and reprint requests to Dr. M.-C. Lee, Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yungundong Chongnogu, Seoul 110-744, Korea; e-mail: mclee{at}plaza.snu.ac.kr

BACKGROUND: Temporal evolution of regional hyperperfusion in the late postictal stage in epilepsy has not been clearly defined.

OBJECTIVE: To establish the late temporal evolution of the perfusion in epileptogenic zones using 6-hour postictal SPECT.

METHODS: Ictal 99mTc-hexamethylpropyleneamine oxime (99mTc-HMPAO) SPECT was performed in 10 patients with intractable epilepsy (4 temporal lobe epilepsy, 6 neocortical epilepsy) followed by delayed acquisition and another 6-hour postictal SPECT after reinjection of 99mTc-HMPAO. The delayed acquired SPECT was subtracted from the reinjection SPECT to yield the 6-hour postictal SPECT. Interictal SPECT was acquired on another day. Late postictal perfusion was examined visually, and asymmetric indexes were compared with each other on ictal, 6-hour postictal, and interictal SPECT.

RESULTS: Ictal SPECT images of delayed acquisition were visually and quantitatively similar to those of early acquisition. In 7 of 10 patients, 6-hour postictal SPECT showed hyperperfusion. In one patient, the 6-hour postictal SPECT image showed less perfusion than the interictal SPECT image in the epileptogenic zone.

CONCLUSIONS: Late postictal hyperperfusion was found in more than half of the patients. Postictal perfusion abnormalities did not come back to the interictal phase 6 hours after ictus and these were identified on ictal/postictal 99mTc- HMPAO SPECT.






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