Eur J Nucl Med Mol Imaging (2009) 36:823–830 DOI 10.1007/s00259-008-1040-6
ORIGINAL ARTICLE
Dynamic perfusion patterns in temporal lobe epilepsy Patrick Dupont & John J. Zaknun & Alex Maes & Supatporn Tepmongkol & Silvia Vasquez & C. S. Bal & Wim Van Paesschen & Silvina Carpintiero & Chaichon Locharernkul & Maurizio Dondi
Received: 10 October 2008 / Accepted: 28 November 2008 / Published online: 13 January 2009 # Springer-Verlag 2009
Abstract Purpose To investigate dynamic ictal perfusion changes during temporal lobe epilepsy (TLE). Methods We investigated 37 patients with TLE by ictal and interictal SPECT. All ictal injections were performed within 60 s of seizure onset. Statistical parametric mapping was used to analyse brain perfusion changes and temporal relationships with injection time and seizure duration as covariates. Results The analysis revealed significant ictal hyperperfusion in the ipsilateral temporal lobe extending to subcortical regions. Hypoperfusion was observed in large extratemporal areas. There were also significant dynamic changes in several extratemporal regions: ipsilateral orbitofrontal and bilateral superior frontal gyri and the contralateral cerebellum and ipsilateral striatum. Conclusion The study demonstrated early dynamic perfusion changes in extratemporal regions probably involved in both
propagation of epileptic activity and initiation of inhibitory mechanisms. Keywords Perfusion imaging . Network . Surround inhibition . Seizure cessation
Introduction Hippocampal sclerosis (HS) is the most common form of refractory temporal lobe epilepsy (TLE) [1, 2]. Complex partial seizures are the predominant seizure type associated with HS [1, 2]. The localizing power of ictal single photon emission computed tomography (SPECT) performed with cerebral perfusion imaging agents in patients with partial epilepsy is based on an increase in cerebral blood flow associated with an ictal increase in neuronal metabolic activity [3, 4].
P. Dupont : A. Maes : W. Van Paesschen Nuclear Medicine, Medical Imaging Center and Neurology, KU Leuven/UZ Gasthuisberg, Leuven, Belgium
S. Tepmongkol : C. Locharernkul Nuclear Medicine and Neurology, Chulalongkorn University, Bangkok, Thailand
J. J. Zaknun (*) : M. Dondi Nuclear Medicine Section, Division of Human Health, International Atomic Energy Agency (IAEA), Wagramer Strasse 5, PO BOX 200, A-1400 Vienna, Austria e-mail:
[email protected]
S. Vasquez : S. Carpintiero Nuclear Medicine, Fleni Instituto de Investigaciones Neurologicas, Buenos Aires, Argentina
J. J. Zaknun Department of Nuclear Medicine, University Hospital of Innsbruck, Innsbruck, Austria
C. S. Bal Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
A. Maes Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium
M. Dondi Nuclear Medicine, Ospedale Maggiore, Bologna, Italy
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Eur J Nucl Med Mol Imaging (2009) 36:823–830
Fig. 1 SPM analysis of ictal cerebral perfusion changes in TLE. a Regions with a significant perfusion change (pcor
