Brain spect in the pre-surgical evaluation of epileptic patients preliminary results

Buchpiguel, Carlos A.; Cukiert, Arthur; Hironaka, Fausto H.; Cerri, Giovani G.; Magalhães, Alvaro E. A.; Marino Jr., Raul

doi:10.1590/S0004-282X1992000100007

Abstracts

Pre-surgical evaluation of epileptic patients consists of neurological examination, intensive electroencephalographic (EEG) monitoring and anatomical studies (CT and MRI). Functional methods such as PET and SPECT imaging are now used more frequently. We have studied pre-operatively 15 adult epileptic patients (8 female, 7 male) using a rotational scintillation camera interfaced to a dedicated computer. The tomographic images were obtained 15 minutes after intravenous injection of 99mTc_HMPAO. All had MRI scanning and intensive EEG monitoring which generally included seizure recording. Five patients had progressive lesions (3 meningiomas, 2 astrocytomas). In 10 patients, neuroradiological studies did not show the presence of progressive lesions (2 normal scans and 8 cases with inactive lesions). Two patients with meningioma showed hypoperfusion at the lesion site while the third patient had a marked hyperperfusion which might correlate with the clinical diagnosis of epilepsia partialis continua. In the astrocytoma patients SPECT scans showed hypoperfusion at the lesion site. Data obtained from the 10 patients without progressive CNS lesions showed: (a) in 4, SPECT findings correlated well with the anatomical findings; (b) in 5 instances, SPECT was able to disclose additional functional deficits; (c) in one case, there was no SPECT correlate of a discrete anatomical lesion. In 5 of these cases with no progressive lesions (n=10) SPECT findings were useful as a complementary tool in determining the clinical or surgical management of these patients. Despite the small number and hete-rogenicity of the present sample, SPECT seems to be an useful tool as part of the clinical workup of epileptic patients who are candidates for epilepsy surgery.

SPECT; epilepsy; surgery; pre-operative evaluation

A avaliação pré-operatória de pacientes epilépticos consiste basicamente de exame neurológico, monitorização intensiva de EEG e estudos anatômicos (CT e RMN). Métodos funcionais como PET e SPECT têm sido utilizados mais frequentemente nos últimos anos. Foi realizada a investigação pré-operatória em 15 pacientes epilépticos adultos (8 mulheres, 7 homens) utilizando câmara de cintilação rotacional acoplada a computador. As imagens tomográficas foram obtidas 15 minutos após a injeção de 99mTC HMPAO. Todos os pacientes foram submetidos a RMN e monitorização intensiva de EEG, que geralmente inclui registros letais. Cinco pacientes possuíam lesões expansivas (3 meningeomas e 2 as troei tomas). Em 10 pacientes, os estudos neurorradiológicos não mostraram presença de lesões expansivas (2 normais e 8 com lesões inativas). O estudo de 2 pacientes com meningeomas mostrou presença de hipoperfusão ao nível da lesão, enquanto em um terceiro caso marcada hiperperfusão foi detectada e, neste paciente, provavelmente correlacionava-se quadro de epilepsia partialis continua. Nos pacientes com astrocitomas, os exames de SPECT mostraram hipoperfusão no local da lesão. Os dados obtidos em pacientes não portadores de lesões expansivas do sistema nervoso mostraram: (a) em 4 casos os achados de SPECT. correlacionaram-se bem aos achados anatômicos; (b) em 5 casos, os achiados de SPECT mostraram déficits de fluxo adicionais a lesão anatômica; (c) em um caso, não houve correlação entre os achados de SPECT e uma pequena lesão anatômica. Em 5 casos com lesões não progressivas (n = 10) os achados de SPECT foram úteis na determinação da conduta clínica ou cirúrgica. Apesar do pequeno número e da heterogeneidade da presente amostra, o SPECT parece ser importante método complementar no arsenal elínico-propedêutico de pacientes epilépticos candidatos a cirurgia.

SPECT; epilepsia; cirurgia; avaliação pré-operatória

Brain spect in the pre-surgical evaluation of epileptic patients preliminary results

SPECT cerebral na avaliação pré-cirúrgica de pacientes epilépticos

Carlos A. Buchpiguel^I; Arthur Cukiert^II; Fausto H. Hironaka^I; Giovani G. Cerri^I; Alvaro E. A. Magalhães^I; Raul Marino Jr.^II

^IDisciplina de Neurocirurgia do Departamento de Neurologia. Centro de Medicina Nuclear do Departamento de Radiologia

^IIFaculdade de Medicina da Universidade de São Paulo (FMUSP). Centro de Medicina Nuclear do Departamento de Radiologia

SUMMARY

Pre-surgical evaluation of epileptic patients consists of neurological examination, intensive electroencephalographic (EEG) monitoring and anatomical studies (CT and MRI). Functional methods such as PET and SPECT imaging are now used more frequently. We have studied pre-operatively 15 adult epileptic patients (8 female, 7 male) using a rotational scintillation camera interfaced to a dedicated computer. The tomographic images were obtained 15 minutes after intravenous injection of 99mTc_HMPAO. All had MRI scanning and intensive EEG monitoring which generally included seizure recording. Five patients had progressive lesions (3 meningiomas, 2 astrocytomas). In 10 patients, neuroradiological studies did not show the presence of progressive lesions (2 normal scans and 8 cases with inactive lesions). Two patients with meningioma showed hypoperfusion at the lesion site while the third patient had a marked hyperperfusion which might correlate with the clinical diagnosis of epilepsia partialis continua. In the astrocytoma patients SPECT scans showed hypoperfusion at the lesion site. Data obtained from the 10 patients without progressive CNS lesions showed: (a) in 4, SPECT findings correlated well with the anatomical findings; (b) in 5 instances, SPECT was able to disclose additional functional deficits; (c) in one case, there was no SPECT correlate of a discrete anatomical lesion. In 5 of these cases with no progressive lesions (n=10) SPECT findings were useful as a complementary tool in determining the clinical or surgical management of these patients. Despite the small number and hete-rogenicity of the present sample, SPECT seems to be an useful tool as part of the clinical workup of epileptic patients who are candidates for epilepsy surgery.

Key words: SPECT, epilepsy, surgery, pre-operative evaluation.

RESUMO

A avaliação pré-operatória de pacientes epilépticos consiste basicamente de exame neurológico, monitorização intensiva de EEG e estudos anatômicos (CT e RMN). Métodos funcionais como PET e SPECT têm sido utilizados mais frequentemente nos últimos anos. Foi realizada a investigação pré-operatória em 15 pacientes epilépticos adultos (8 mulheres, 7 homens) utilizando câmara de cintilação rotacional acoplada a computador. As imagens tomográficas foram obtidas 15 minutos após a injeção de 99mTC HMPAO. Todos os pacientes foram submetidos a RMN e monitorização intensiva de EEG, que geralmente inclui registros letais. Cinco pacientes possuíam lesões expansivas (3 meningeomas e 2 as troei tomas). Em 10 pacientes, os estudos neurorradiológicos não mostraram presença de lesões expansivas (2 normais e 8 com lesões inativas). O estudo de 2 pacientes com meningeomas mostrou presença de hipoperfusão ao nível da lesão, enquanto em um terceiro caso marcada hiperperfusão foi detectada e, neste paciente, provavelmente correlacionava-se quadro de epilepsia partialis continua. Nos pacientes com astrocitomas, os exames de SPECT mostraram hipoperfusão no local da lesão. Os dados obtidos em pacientes não portadores de lesões expansivas do sistema nervoso mostraram: (a) em 4 casos os achados de SPECT. correlacionaram-se bem aos achados anatômicos; (b) em 5 casos, os achiados de SPECT mostraram déficits de fluxo adicionais a lesão anatômica; (c) em um caso, não houve correlação entre os achados de SPECT e uma pequena lesão anatômica. Em 5 casos com lesões não progressivas (n = 10) os achados de SPECT foram úteis na determinação da conduta clínica ou cirúrgica. Apesar do pequeno número e da heterogeneidade da presente amostra, o SPECT parece ser importante método complementar no arsenal elínico-propedêutico de pacientes epilépticos candidatos a cirurgia.

Palavras chaves: SPECT, epilepsia, cirurgia, avaliação pré-operatória.

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Full text available only in PDF format.

Dr. Carlos Alberto Buchpiguel Centro de Medicina Nuclear, FMUSP - Caixa Postal 22022 01499 São Paulo SP - Brasil.

1. Abou-Khalil BW, Siegel GJ, Sackellares JC. PET studies of cerebral glucose metabolism in chronic partial epilepsies. Ann Neurol 1987. 22:480-486.
2. Engel JJr, Babb TL, Phelps ME. Contribution of positron emission tomography to understanding mechanisms of epilepsy. In Engel J (ed): Fundamental Mechanisms of Human Brain Function. New York: Raven Press, 1987, p 209-218.
3. Lee BI, Markand ON, Sidigui AR, Park HM, Mock B, Wellman HH, Worth RM, Edwards MK. SPECT brain imaging using HIPDM: intractable complex partial seizures. Neurology 1986, 36:1471-1477.
4. Ochs RF, Gloor P, Tyler JF. Effects of generalized spike-and-wave discharge on glucose metabolism measured by PET. Ann Neurol 1987, 21:458-464.
5. Sackhellares JC, Siegel JC, Abou-Khalil BW, Hood TW, Gilman S, McKeever PE, Hichwa RD, Hutchins GD. Differences between lateral and mesial temporal metabolism interictally in epilepsy of mesial temporal origin. Neurology 1990, 40:1420-1426.
6. Stefan H, Bocher_Schwarz HG, Biersack HJ, Burr W, Penin H, Heiss WD. Functional and morphological abnormalities in temporal lobe epilepsy: a comparison of interictal and ictal EEG, CT, MRI, SPECT and PET. J Neurol 1987, 234:377-384.
7. Swartz BE, Halgren E, Delgado-Escueta AV, Mandelkern M, Gee M, Quinones N, Blahd WH, Repchan J. Neuroimaging in patients with seizures of probable frontal lobe origin. Epilepsia 1989, 30:547-558.
8. Theodore WH, Dorwart R, Holmes M. Neuroimaging in refractory partial seizures: comparison of PET, CT and MRI. Neurology 1986, 36:750-759.
9. Theodore WH, FishbeinD, Dubinsk R. Patterns of cerebral glucose metabolism in patients with partial seizures. Neurology 1988, 38:1201-1206.

Publication Dates

Publication in this collection
22 Feb 2011
Date of issue
Mar 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Abou-Khalil BW, Siegel GJ, Sackellares JC. PET studies of cerebral glucose metabolism in chronic partial epilepsies. Ann Neurol 1987. 22:480-486.

[2] 2. Engel JJr, Babb TL, Phelps ME. Contribution of positron emission tomography to understanding mechanisms of epilepsy. In Engel J (ed): Fundamental Mechanisms of Human Brain Function. New York: Raven Press, 1987, p 209-218.

[3] 3. Lee BI, Markand ON, Sidigui AR, Park HM, Mock B, Wellman HH, Worth RM, Edwards MK. SPECT brain imaging using HIPDM: intractable complex partial seizures. Neurology 1986, 36:1471-1477.

[4] 4. Ochs RF, Gloor P, Tyler JF. Effects of generalized spike-and-wave discharge on glucose metabolism measured by PET. Ann Neurol 1987, 21:458-464.

[5] 5. Sackhellares JC, Siegel JC, Abou-Khalil BW, Hood TW, Gilman S, McKeever PE, Hichwa RD, Hutchins GD. Differences between lateral and mesial temporal metabolism interictally in epilepsy of mesial temporal origin. Neurology 1990, 40:1420-1426.

[6] 6. Stefan H, Bocher_Schwarz HG, Biersack HJ, Burr W, Penin H, Heiss WD. Functional and morphological abnormalities in temporal lobe epilepsy: a comparison of interictal and ictal EEG, CT, MRI, SPECT and PET. J Neurol 1987, 234:377-384.

[7] 7. Swartz BE, Halgren E, Delgado-Escueta AV, Mandelkern M, Gee M, Quinones N, Blahd WH, Repchan J. Neuroimaging in patients with seizures of probable frontal lobe origin. Epilepsia 1989, 30:547-558.

[8] 8. Theodore WH, Dorwart R, Holmes M. Neuroimaging in refractory partial seizures: comparison of PET, CT and MRI. Neurology 1986, 36:750-759.

[9] 9. Theodore WH, FishbeinD, Dubinsk R. Patterns of cerebral glucose metabolism in patients with partial seizures. Neurology 1988, 38:1201-1206.