Clinical value of "ictal" FDG positron emission tomography and the routine use of simultaneous scalp EEG studies in patients with intractable partial epilepsies

被引:40
作者
Barrington, SF
Koutroumanidis, M
Agathonikou, A
Marsden, PK
Binnie, CD
Polkey, CE
Maisey, MN
Panayiotopoulos, CP
机构
[1] St Thomas Hosp, Guys & St Thomas Clin PET Ctr, London SE1 7EH, England
[2] St Thomas Hosp, Dept Clin Neurophysiol & Epilepsies, London SE1 7EH, England
[3] Univ London Kings Coll Hosp, Dept Clin Neurophysiol, London, England
[4] Univ London Kings Coll Hosp, Dept Neurosurg, London, England
关键词
positron emission tomography; ictal; epilepsy; seizure; glucose metabolism;
D O I
10.1111/j.1528-1157.1998.tb01162.x
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Purpose: EEG is widely used during positron emission tomography (PET) to confirm the interictal state of the patient and assist in scan interpretation when a seizure occurs. Ictal scans usually reflect mixed interictal-ictal-postictal metabolic activity as seizures are brief in comparison to the 30-min uptake period of the tracer. We wished to determine whether routine EEG is justified and if seizures commonly affect the diagnostic information of the PET scan. Methods: We examined the PET scans of 6 of 236 outpatients with intractable epilepsy with clinical and electrical evidence of a seizure during tracer uptake. We performed semiquantitative analysis in 2 patients who had "ictal'' and control interictal scans. Results: Patients with single seizures lasting 23 s to 4 min [four complex partial seizures (CPS) and one absence seizure (AS)] had focal hypometabolism concordant with results of other investigations. One patient with complex partial status had irregular cortical uptake and focal hypometabolism, but the site of the ictal focus could not be confirmed. Conclusions: In this group of patients, seizures occurred infrequently during tracer uptake. The interpretation of the PET scan when single seizures occurred did not appear to be influenced by the continuous scalp EEG (CSEEG) recordings. The value of routine CSEEG in outpatients treated with medication should be reappraised, with potential cost savings. In rare circumstances in which a true ictal study occurs (complex partial status, epilepsia partialis continua, and repetitive CPS), PET scanning may be inconclusive and repeat interictal scanning should be pursued.
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页码:753 / 766
页数:14
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