Brain, Vol 120, Issue 11 1921-1928, Copyright © 1997 by Oxford University Press
SS Ho, MR Newton, AM McIntosh, RM Kalnins, GC Fabinyi, GA Brazenor, WJ McKay, PF Bladin and SF Berkovic
We sought to determine whether patterns of ictal hyperfusion demonstrated
using [99mTC]HMPAO (hexamethylpropylene amine oxime) single photon emission
computed tomography (SPECT) predict outcome of temporal lobectomy; in
particular, whether the more extensive patterns of ictal hyperperfusion are
associated with poor outcome. We studied 63 patients who had ictal SPECT
studies prior to temporal lobectomy. Hyperperfusion on ictal SPECT scans
was lateralized, and classified into: (i) 'typical', (ii) 'typical with
posterior extension', (iii) 'bilateral' and (iv) 'atypical' patterns.
Outcome (minimum of 2 years follow-up) was classified as either seizure
free, or not seizure free. Actuarial analysis was used to test the
relationship of SPECT patterns with outcome. There were 35 cases with the
typical ictal SPECT pattern, 13 posterior, nine bilateral and six atypical
cases. The atypical pattern was associated with lack of pathology in the
surgical specimen. Outcome was similar for the typical, posterior and
bilateral with 60%, 69% and 67% seizure free, respectively. In contrast,
the atypical group had a worse outcome with only 33% seizure free.
Actuarial analysis showed a significant difference in outcome between
patients with the typical pattern, and patients with the atypical pattern
(P = 0.04). We conclude that extended patterns of ictal perfusion in
temporal lobe epilepsy do not predict poor outcome, indicating that
extended hyperperfusion probably represents seizure propagation pathways
rather than intrinsically epileptogenic tissue. Atypical patterns of
hyperperfusion are associated with poor outcome and may indicate diffuse or
extra-temporal epileptogenicity.
ARTICLES
Perfusion patterns during temporal lobe seizures: relationship to surgical outcome
Department of Neurology, Austin and Repatriation Medical Centre, Melbourne, Australia.
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