SPECT perfusion changes during complex partial seizures in patients with hippocampal sclerosis.

Cerebral perfusion changes reliably reflect changes in neuronal activity. Our aim was to obtain new insights into the pathophysiology of complex partial seizures (CPS) in patients with hippocampal sclerosis (HS) using interictal and ictal single photon emission computed tomography (SPECT). We studied 24 patients with refractory temporal lobe epilepsy (TLE) associated with HS. All had an interictal and ictal SPECT with early injection during a CPS. Images were normalized and co-registered. Using statistical parametric mapping (SPM99), brain regions with significant ictal perfusion changes were determined. To assess possible interrelationships between these regions, Pearson correlation coefficients were calculated. The temporal lobe ipsilateral to the seizure focus, the border of the ipsilateral middle frontal and precentral gyrus, both occipital lobes and two small regions in the contralateral postcentral gyrus showed ictal hyperperfusion. The frontal lobes, contralateral posterior cerebellum and ipsilateral precuneus showed hypoperfusion. Further exploratory analysis suggested an association between ipsilateral temporal lobe hyperperfusion and ipsilateral frontal lobe hypoperfusion, and an inverse association between seizure duration and hyperperfusion in the ipsilateral anterior cerebellum and contralateral postcentral gyrus. We conclude that there is a network of perfusion changes during CPS in patients with HS. Studying a particular seizure type in patients with HS with peri-ictal SPECT performed during a defined time window will allow further analysis of the cerebral network activities, and excitatory, inhibitory and gating mechanisms during seizures associated with HS.

[1]  R. Mattson,et al.  Characteristics of medial temporal lobe epilepsy: II. Interictal and ictal scalp electroencephalography, neuropsychological testing, neuroimaging, surgical results, and pathology , 1993, Annals of neurology.

[2]  J. Fuster.  The Prefrontal Cortex—An Update Time Is of the Essence , 2001, Neuron.

[3]  P H Crandall,et al.  Ictal localization of temporal lobe seizures with scalp/sphenoidal recordings , 1989, Neurology.

[4]  R. Snider,et al.  Cerebellar Control of Basal Forebrain Seizures: Amygdala and Hippocampus * , 1975, Epilepsia.

[5]  I. Cooper,et al.  Clinical and Physiological Effects of Stimulation of the Paleocerebellum in Humans , 1973, Journal of the American Geriatrics Society.

[6]  C. Elger,et al.  Inhibitory effects of mesial temporal partial seizures onto frontal neocortical structures. , 1998, Acta neurologica Belgica.

[7]  K. Till.  VIRUSES AND TUMOURS. , 1964, Lancet.

[8]  C. Paz,et al.  Amygdala kindling in totally cerebellectomized cats , 1985, Experimental Neurology.

[9]  R. Mattson,et al.  Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy. , 1989, Epilepsia.

[10]  R Duncan,et al.  Ictal/postictal SPECT in the pre-surgical localisation of complex partial seizures. , 1993, Journal of neurology, neurosurgery, and psychiatry.

[11]  R. Mutani,et al.  Experimental Evidence for the Existence of an Extrarhinencephalic Control of the Activity of the Cobalt Rhinencephalic Epileptogenic Focus , 1969 .

[12]  P. Gloor,et al.  Occipitotemporal Epilepsies: Evaluation of Selected Patients Requiring Depth Electrodes Studies and Rationale for Surgical Approaches , 1993, Epilepsia.

[13]  I Savic,et al.  Localized Cerebellar Hypometabolism in Patients with Complex Partial Seizures , 1996, Epilepsia.

[14]  Karl J. Friston,et al.  Statistical parametric maps in functional imaging: A general linear approach , 1994 .

[15]  L. Vodovnik,et al.  Chronic Cerebellar Stimulation in the Treatment of Epilepsy , 1987 .

[16]  Cerebellar control of amygdaloid seizures. , 1975, Transactions of the American Neurological Association.

[17]  S. Berkovic.  SPECT: neurobiology of periictal blood flow alterations. , 2000, Advances in neurology.

[18]  D. Seo,et al.  Ictal hyperperfusion of cerebellum and basal ganglia in temporal lobe epilepsy: SPECT subtraction with MRI coregistration. , 2001, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[19]  B. I. Lee,et al.  Increased contralateral cerebellar uptake of technetium-99m-HMPAO on ictal brain SPECT. , 1996, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[20]  W J McKay,et al.  SPECT in the localisation of extratemporal and temporal seizure foci. , 1995, Journal of neurology, neurosurgery, and psychiatry.

[21]  H. Seto,et al.  Contralateral cerebellar activation in frontal lobe epilepsy detected by ictal Tc-99m HMPAO brain SPECT. , 1997, Clinical nuclear medicine.

[22]  R. Fisher,et al.  Cerebellar and thalamic stimulation for epilepsy. , 1993, Advances in neurology.

[23]  R. Mutani,et al.  Experimental Evidence for the Existence of an Extrarhinencephalic Control of the Activity of the Cobalt Rhinencephalic Epileptogenic Focus , 1969, Epilepsia.

[24]  A. Rabinowicz,et al.  Changes in Regional Cerebral Blood Flow Beyond the Temporal Lobe in Unilateral Temporal Lobe Epilepsy , 1997, Epilepsia.

[25]  D. Spencer,et al.  Characteristics of medial temporal lobe epilepsy: I. Results of history and physical examination , 1993, Annals of neurology.

[26]  Guy Marchal,et al.  Multimodality image registration by maximization of mutual information , 1997, IEEE Transactions on Medical Imaging.

[27]  W J McKay,et al.  Temporal Lobe Epilepsy Subtypes: Differential Patterns of Cerebral Perfusion on Ictal SPECT , 1996, Epilepsia.

[28]  Jacqueline A. French,et al.  Characteristics of medial temporal lobe epilepsy , 1993 .

[29]  A Connelly,et al.  Optimizing the diagnosis of hippocampal sclerosis using MR imaging. , 1993, AJNR. American journal of neuroradiology.

[30]  S. Kim,et al.  The Clinical Usefulness of Ictal SPECT in Temporal Lobe Epilepsy: The Lateralization of Seizure Focus and Correlation with EEG , 2000, Epilepsia.

[31]  R. Woodhams,et al.  Interictal crossed cerebellar hyperperfusion on Tc-99m ECD SPECT , 2001, Annals of nuclear medicine.

[32]  D. Mclellan,et al.  A double-blind trial of chronic cerebellar stimulation in twelve patients with severe epilepsy. , 1984, Journal of neurology, neurosurgery, and psychiatry.

[33]  M. Kurthen,et al.  Crossed cerebellar diaschisis in intracarotid sodium amytal procedures: a SPECT study , 1990, Acta neurologica Scandinavica.

[34]  W T Blume,et al.  A randomized, controlled trial of surgery for temporal-lobe epilepsy. , 2001, The New England journal of medicine.

[35]  W. van Paesschen,et al.  Self-injection ictal SPECT during partial seizures , 2000, Neurology.

[36]  Seung Bong Hong,et al.  Ictal hyperperfusion patterns according to the progression of temporal lobe seizures , 2002, Neurology.

[37]  Jerome Engel,et al.  Role of the Frontal Lobes in the Propagation of Mesial Temporal Lobe Seizures , 1991, Epilepsia.

[38]  Alan C. Evans,et al.  A Three-Dimensional Statistical Analysis for CBF Activation Studies in Human Brain , 1992, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[39]  B P Mullan,et al.  Cerebellar Changes in Partial Seizures: Clinical Correlations of Quantitative SPECT and MRI Analysis , 1998, Epilepsia.

[40]  Karl J. Friston,et al.  Spatial registration and normalization of images , 1995 .

[41]  G. Egan,et al.  Comparison of ictal SPECT and interictal PET in the presurgical evaluation of temporal lobe epilepsy , 1995, Annals of neurology.

[42]  D. Prince,et al.  Control mechanisms in cortical epileptogenic foci. "Surround" inhibition. , 1967, Archives of neurology.

[43]  S. Spencer,et al.  Nontumoral occipitotemporal epilepsy: Localizing findings and surgical outcome , 1999, Annals of neurology.

[44]  S. Spencer.  Neural Networks in Human Epilepsy: Evidence of and Implications for Treatment , 2002, Epilepsia.

[45]  I S Cooper,et al.  Effect of chronic stimulation of anterior cerebellum on neurological disease. , 1973, Lancet.

[46]  Theodore H. Schwartz,et al.  In vivo optical mapping of epileptic foci and surround inhibition in ferret cerebral cortex , 2001, Nature Medicine.

[47]  Karl J. Friston,et al.  A unified statistical approach for determining significant signals in images of cerebral activation , 1996, Human brain mapping.

[48]  W. van Paesschen,et al.  Simple design for rapid self-injection ictal SPET during aura. , 1999, European journal of nuclear medicine.

[49]  R. Walovitch,et al.  Intrasubject comparison between technetium-99m-ECD and technetium-99m-HMPAO in healthy human subjects. , 1992, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[50]  Guy Marchal,et al.  Multi-modality image registration by maximization of mutual information , 1996, Proceedings of the Workshop on Mathematical Methods in Biomedical Image Analysis.