Ictal SPECT and Interictal PET in the Localization of Occipital Lobe Epilepsy

• Published in: Epilepsia (Copenhagen) Vol. 41; no. 4; pp. 463 - 466
• Main Authors: Sturm, Jonathan W., Newton, Mark R., Chinvarun, Yotin, Berlangieri, Salvatore U., Berkovic, Samuel F.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.04.2000; Blackwell
• Subjects: Adult; Age of Onset; Biological and medical sciences; Epilepsies, Partial - diagnosis; Epilepsies, Partial - diagnostic imaging; Epilepsies, Partial - physiopathology; Female; Fluorodeoxyglucose F18; Functional imaging; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Occipital epilepsy; Occipital Lobe - anatomy & histology; Occipital Lobe - diagnostic imaging; Occipital Lobe - physiopathology; PET; SPECT; Temporal Lobe - anatomy & histology; Temporal Lobe - diagnostic imaging; Temporal Lobe - physiopathology; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon; Tropical medicine; Radionuclide study; Human; Nervous system diseases; Epileptic focus; Interictus; Metabolism; Photon; Cerebral disorder; Crisis; Occipital lobe epilepsy; Refractory; Central nervous system disease; Adult; Hemodynamics; Laterality; Positron; Emission tomography; Functional imaging
• ISSN: 0013-9580; 1528-1167
• DOI: 10.1111/j.1528-1157.2000.tb00190.x

Purpose: To compare the localizing value of ictal single photon emission computed tomography (SPECT) and interictal fluorodeoxyglucose–positron emission tomography (FDG‐PET) in refractory occipital lobe epilepsy. Methods: Six patients who underwent surgery for refractory epilepsy associated with pathology in the occipital lobe were retrospectively selected from records of the Austin & Repatriation Centre Comprehensive Epilepsy Programme. Interictal SPECT and PET and ictal SPECT were obtained by standard methods. All studies were read by a nuclear medicine expert blinded to clinical data except the diagnosis of epilepsy. Results: Ictal SPECT showed unilateral occipital hyperperfusion in five of six cases often accompanied by temporal lobe hyperperfusion. These patterns were seen in cases with or without magnetic resonance imaging (MRI) abnormality. Interictal SPECT was not localizing in any case, in contrast to PET, which showed occipital hypometabolism in three of five studies. Conclusions: Ictal SPECT can provide novel localizing data in MRI‐negative occipital lobe epilepsy. Interictal PET can provide useful localizing information, but its role in providing novel information was not demonstrated. Interictal SPECT is useful only as a baseline to aid in interpretation of ictal studies.