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Neurology· 1991Q1

Patterns of postictal cerebral blood flow in temporal lobe epilepsy

Christopher Cleon Rowe, Samuel Frank Berkovic, M.C. Austin, W. J. Stewart McKay et al.

Short summary

Postictal SPECT imaging revealed increased blood flow in the anteromesial temporal lobe in 83% of 78 seizures studied in 51 temporal lobe epilepsy patients, with 80% showing concurrent reduced flow in the lateral temporal lobe.

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Key points

  • Increased focal temporal lobe blood flow (83%) and reduced lateral temporal lobe activity (80%) were observed post-seizure in temporal lobe epilepsy patients via SPECT.
  • These blood flow patterns were predominantly confined to the anteromesial region and declined rapidly within 5 minutes.
  • Postictal SPECT imaging correctly localized unilateral EEG foci in 69% of patients, with a 97% positive predictive value.
  • The findings suggest postictal CBF imaging can aid noninvasive electrographic localization in epilepsy.

AI-generated from the title and abstract; the full text is not read.

Abstract

We used single-photon emission computed tomography (SPECT) to study postictal cerebral blood flow (CBF) in 51 patients with temporal lobe epilepsy. There were 78 seizures studied, 77 by early postictal injection of Tc-99m HMPAO (delay from seizure onset = 4.3 +/- 4.5 min) and one by ictal injection. Increased focal temporal lobe uptake, predominantly confined to the anteromesial region, was present in 83% and declined rapidly over 5 minutes. Reduced activity in the lateral temporal lobe accompanied the mesial increase in 80% of studies, extending over much of the ipsilateral hemisphere and closely associated with the degree and extent of postictal EEG slow waves. These patterns enabled correct seizure localization by blinded analysis in 69% (31/45) of the patients with a unilateral EEG focus. The remainder showed bilateral or no changes. One of six patients with bitemporal EEG foci had unilateral perfusion changes. The positive predictive value for the correct localization of a unilateral focus by postictal SPECT was 97% (31/32). Postictal CBF imaging with SPECT can be used to support noninvasive electrographic localization and may decrease the need for invasive electrode studies.

The authors' abstract, as published at the source. Neurology, 1991 · DOI ↗

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Field: Psychiatry and Mental health

Psychiatry and Mental healthMedicine