Ictal Hyperperfusion of Cerebellum and Basal Ganglia in Temporal Lobe Epilepsy: SPECT Subtraction and MRI Co-Registration
Abstract number :
1.235
Submission category :
Year :
2000
Submission ID :
1392
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Won Chul Shin, Seung Bong Hong, Woo Suk Tae, Dae Won Seo, Samsung Medical Ctr, Sungkyunkwan Univ, Seoul, South Korea.
RATIONALE: Cerebellar hyperperfusion (CH)is often observed in ictal SPECT of patients with temporal lobe epilepsy (TLE). The ictal hyperperfusions in cerebellum and basal ganglia were analyzed in TLE using SPECT subtraction co-registered with MRI. METHODS: Twenty-six TLE patients had interictal, ictal SPECT, video-EEG monitoring and volumetric MRI. SPECT subtraction with MRI co-registration was performed using Analyze 7.5 software. The presence of ictal hyperperfusion was determined in ipsilateral and contralateral temporal lobe, frontal lobe, cerebellum and basal ganglia. RESULTS: All patients showed ictal hyperperfusion in the temporal lobe of seizure origin. The vermian CH was observed in 22 patients (84.6%) and hemispheric CH in 16(61.5%). Compared to the side of epileptogenic temporal lobe, there were six ipsilateral hemispheric CH (37.5%), eight contralateral hemispheric CH (50%) and 2 bilateral hemispheric CH (12.5%). CH was more frequently observed in the patients with additional frontal hyperperfusion (11/14, 78.6%) than in the patients without frontal hyperperfusion (5/12, 41.7%). Among 12 patients who had only temporal hyperperfusion without frontal hyperperfusion, five patients showed hemispheric CH (ipsilateral to seizure focus, 3; contralateral, 2). The basal ganglia hyperperfusion (BGH) were seen in 11 of 14 with temporal + frontal hyperperfusion (78.6%) and 5 of 12 with temporal hyperperfusion only (41.7%). The 12 patients with unilateral BGH (right 2, left 10) always showed hemispheric CH contralateral to the side of BGH. CONCLUSIONS: Hemispheric CH during seizures of TLE was observed on ipsilateral, contralateral or bilateral cerebellar hemisphere to the side of seizure origin. Temporal lobe origin seizures associated with frontal hyperperfusion had more frequent hemispheric CH. However, seizures showing only temporal hyperperfusion without frontal hyperperfusion could produce BGH and CH. Not the side of seizure origin but the side of BGH was the most important factor for determining the side of hemispheric CH in TLE.