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Usefulness of Ictal and Interictal 99m TC Ethyl Cysteinate Dimer Single Photon Emission Computed Tomography in Patients with Refractory Partial Epilepsy
Author(s) -
Lancman Marcelo E.,
Morris Harold H.,
Raja Shanker,
Sullivan M. Jo,
Saha Gopal,
Go Raymundo
Publication year - 1997
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1157.1997.tb01737.x
Subject(s) - ictal , ictal interictal spect analysis by spm , epilepsy , nuclear medicine , single photon emission computed tomography , emission computed tomography , temporal lobe , medicine , perfusion , psychology , anesthesia , radiology , positron emission tomography , neuroscience
Summary:Purpose: Ictal perfusion single photon emission computed tomography (SPECT), using HMPAO, has been shown to localize epileptic foci in ∼90% of studies. Unfortunately, HMPAO decomposes rapidly, precluding the performance of ictal studies. Ethyl cysteinate dimer (ECD) is a SPECT perfusion agent recently approved by the Food and Drug Administration. After preparation, this compound is stable for ∼6 h. facilitating the performance of ictal studies. Methods: In a prospective, open‐label, uncontrolled, non randomized study, we evaluated the potential benefits of the use of 99m Tc‐ECD SPECT for lateralization of the epileptic focus. Ten consecutive adult epilepsy surgery candidates were studied with ictal and interictal 99m Tc‐ECD SPECT. Results: The mean delay between seizure onset and ictal SPECT injection was 23.2 s. The mean seizure duration was 84.1 s. Ictal studies agreement between the epilepsy focus and area of hyperperfusion was evident in 8 of 10 cases. In one case, SPECT was lateralized in a patient with bilateral temporal lobe epilepsy (TLE); however, hyperperfusion was observed on the same side of that particular seizure. In another case, there was location disagreement. Interictal SPECT showed focal hypoperfusion in three cases. Conclusions:99m Tc‐ECD proved to be an optimal tracer for ictal studies. Although this is a small series, the results of ictal and interictal findings using 99mTc‐ECD are similar to those reported with 99m Tc‐HMPA0. Because 99m Tc‐ECD has a longer decomposition time, true ictal studies are easier to obtain. This new tracer will probably allow the use of ictal SPECT to become widely accepted in most epilepsy centers.

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