Cerebral Perfusion SPECT Imaging in Epileptic and Nonepileptic Seizures

• Published in: Clinical nuclear medicine 1997-06, Vol.22 (6), p.363-368
• Main Authors: BLEND, MICHAEL J, DE LEóN, OVIDIO A, JOBE, THOMAS H, LIN, QING, SYCHRA, JERRY J, GAVIRIA, MOISÉS
• Format: Article
• Language: English
• Subjects: Adult; Anticonvulsants - therapeutic use; Biological and medical sciences; Brain - diagnostic imaging; Brain - drug effects; Cerebrovascular Circulation; Delta Rhythm; Depression - complications; Diagnosis, Differential; Diazepam - therapeutic use; Electroencephalography; Epilepsy - diagnostic imaging; Epilepsy - drug therapy; Epilepsy - physiopathology; Epilepsy, Complex Partial - diagnostic imaging; Female; Frontal Lobe - diagnostic imaging; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Image Enhancement - methods; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Nervous system; Nervous system (semeiology, syndromes); Neurology; Organotechnetium Compounds; Oximes; Psychophysiologic Disorders - complications; Radionuclide investigations; Radiopharmaceuticals; Seizures - diagnostic imaging; Seizures - drug therapy; Seizures - etiology; Seizures - physiopathology; Subtraction Technique; Technetium Tc 99m Exametazime; Temporal Lobe - diagnostic imaging; Tomography, Emission-Computed, Single-Photon - methods
• ISSN: 0363-9762; 1536-0229
• DOI: 10.1097/00003072-199706000-00003

Patients with epileptic and nonepileptic seizures are commonly encountered in clinical practice, and they can pose a difficult diagnostic problem. We present two cases that show the difficult task of differentiating between true epileptic and nonepileptic or psychogenic seizures in some patients. The clinical presentations were complex and the use of video-monitored EEG alone was insufficient to make definitive diagnoses. Ictal and interictal Tc-99m HMPAO brain perfusion SPECT imaging examinations were used to help establish the correct diagnoses. This report describes the advantage of using the brain perfusion SPECT imaging examination. The injection of stabilized Tc-99m HMPAO during an ictal event followed by appropriate medical therapy provides a ethod of obtaining a reasonable image of relative perfusion(activity) during the seizure. These images can then be compared with interictal examinations and an epileptic or nonepileptic focus may be localized. The Tc-99m HMPAO brain perfusion SPECT imaging study was helpful in establishing the correct diagnosis in both cases.