technetium-tc-99m-bicisate and Seizures

Functional brain imaging plays an important role in seizure focus localisation. However, truly ictal single-photon emission tomography (SPET) studies are not routinely performed owing to technical problems associated with the use of tracers and methodological and logistical difficulties. In this study we tried to resolve both of these issues by means of a new procedure: technetium-99m ethyl cysteinate dimer (ECD) brain SPET performed during seizures pharmacologically provoked with pentylenetetrazol, a well-known central and respiratory stimulant. We studied 33 drug-resistant epileptic patients. All patients underwent anamnestic evaluation, neuropsychological and psychodynamic assessment, magnetic resonance imaging, interictal and ictal video-EEG monitoring, and interictal and ictal SPET with (99m)Tc-ECD. In order to obtain truly ictal SPET, 65 mg of pentylenetetrazol was injected every 2 minutes and, immediately the seizure began, 740 MBq of (99m)Tc-ECD was injected. The scintigraphic findings were considered abnormal if a single area of hyperperfusion was present and corresponded to the site of a single area of hypoperfusion at interictal SPET: the "hypo-hyperperfusion" SPET pattern. In 27 of the 33 patients (82%), interictal-ictal SPET showed the hypo-hyperperfusion SPET pattern. Video-EEG showed a single epileptogenic zone in 21/33 patients (64%), and MRI showed anatomical lesions in 19/33 patients (57%). Twenty-two of the 27 patients with hypo-hyperperfusion SPET pattern underwent ablative or palliative surgery and were seizure-free at 3 years of follow-up. No adverse effects were noted during pharmacologically provoked seizure. It is concluded that ictal brain SPET performed during pharmacologically provoked seizure provides truly ictal images because (99m)Tc-ECD is injected immediately upon seizure onset. Using this feasible procedure it is possible to localise the focus, to avoid the limitations due to the unpredictability of seizures, to avoid pitfalls due to late injection, to avoid intracranial EEG recording and to minimise costs. The clinical value of our method is confirmed by the good outcome after 3 years of follow-up in those patients submitted to ablative or palliative surgery.

Topics: Adolescent; Adult; Cysteine; Drug Resistance; Electroencephalography; Epilepsy; Feasibility Studies; Female; Follow-Up Studies; Humans; Injections; Magnetic Resonance Angiography; Male; Organotechnetium Compounds; Pentylenetetrazole; Radiopharmaceuticals; Reference Values; Seizures; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Video Recording

The aim of this study was to evaluate the use of 99mTc-ethyl cysteinate dimer (ECD), also known as 99mTc-bicisate, in the presurgical evaluation of patients suffering from medically intractable epilepsy.. Twenty-three brain SPECT studies (8 ictally and 15 interictally) were performed on 16 patients with a high-resolution annular SPECT system (CERASPECT). For the ictal studies, the tracer was injected in the very early phase of the seizure. The delay between seizure onset and 99mTc-ECD injection was 2-20 sec.. Interictally, all patients showed circumscribed hypoperfusions. In four patients, the SPECT lesion represented only structural defects. Circumscribed increased tracer uptake was observed in all ictal studies. For all patients with temporal lobe epilepsy without significant mass lesion, in whom an interictal and ictal 99mTc-ECD-SPECT study could be obtained, the asymmetry index was 0.88 +/- 0.03 for the interictal and 1.23 +/- 0.08 for the ictal studies.. The data suggest that 99mTc-ECD is an effective marker of cerebral perfusion imaging in epilepsy. In comparison to other tracers, it has a high in vitro stability and is therefore particularly useful for ictal studies in the very early phase after seizure onset.

Topics: Adolescent; Adult; Brain; Cysteine; Electroencephalography; Epilepsy; Female; Humans; Male; Organotechnetium Compounds; Seizures; Time Factors; Tomography, Emission-Computed, Single-Photon

Ictal brain perfusion SPECT with the tracer 99mTc-HMPAO or 99mTc-ECD is widely used for identification of the epileptic seizure onset zone (SOZ) in presurgical evaluation if standard pointers are uncertain or inconsistent. For both tracers, there are theoretical arguments to favor it over the other for this task. The aim of this study was to compare the performance of ictal brain perfusion SPECT between 99mTc-HMPAO and 99mTc-ECD in a rather large patient sample.. The study retrospectively included 196 patients from clinical routine in whom ictal perfusion SPECT had been performed with stabilized 99mTc-HMPAO (n = 110) or 99mTc-ECD (n = 86). Lateralization and localization of the SOZ were obtained by the consensus of 2 independent readers based on visual inspection of the SPECT images.. The 99mTc-HMPAO group and the 99mTc-ECD group were well matched with respect to age, sex, age at first seizure, duration of disease, seizure frequency, history of previous brain surgery, and findings of presurgical MRI. The proportion of lateralizing ictal SPECT did not differ significantly between 99mTc-HMPAO and 99mTc-ECD (65.5% vs 72.1%, P = 0.36). Sensitivity of ictal perfusion SPECT (independent of the tracer) for correct localization of the SOZ in 62 patients with temporal lobe epilepsy and at least worthwhile improvement (Engel scale ≤ III) 12 months after temporal epilepsy surgery was 63%.. This study does not provide evidence to favor 99mTc-HMPAO or 99mTc-ECD for identification of the SOZ by ictal perfusion SPECT.

Topics: Brain; Cysteine; Electroencephalography; Humans; Organotechnetium Compounds; Perfusion; Retrospective Studies; Seizures; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Brain; Brain Death; Computed Tomography Angiography; Cough; Cysteine; False Positive Reactions; Humans; Intracranial Hemorrhage, Hypertensive; Male; Middle Aged; Organotechnetium Compounds; Perfusion Imaging; Radiopharmaceuticals; Seizures; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Localization of epileptogenic focus in drug-refractory epilepsy using Tc-99m ethylene cystine dimer (ECD) brain single photon emission computed tomography (SPECT) is less studied in patients with discordant findings on video electroencephalogram (VEEG) and MRI. The study was done to evaluate brain SPECT for epileptogenic focus localization and postoperative seizure freedom.. Epilepsy patients with discordant VEEG and MRI findings underwent brain SPECT at ictal and interictal phases. Various groups unilateral/bilateral mesial temporal sclerosis (MTS), solitary and multifocal lesional, nonlesional epilepsy were studied for localization of epileptogenic focus and postoperative seizure freedom (>2 years) using Engels classification. Reasons for nonoperability was evaluated in nonoperated group.. SPECT could localize epileptogenic focus in 49/67 (73.13%) and guided surgery in 19/33 (57.57%) patients in operated group. SPECT was useful in 12 (46.12%) of unilateral (2)/bilateral (10) MTS. Postoperative seizure freedom of Engels Class I and II in 22 (66.67%), III in six (18.2%) and IV in one patient based on SPECT findings (P = 0.0086). Overall sensitivity and specificity were 79.3% and 85.7%, respectively. SPECT could localize epileptogenic focus in 23/34 (67.64%) patients in nonoperated group; 10 (29.41%) patients refused for surgery and no epileptogenic focus was localized in the rest of 14 (41.2%).. Ictal SPECT showed incremental value and was found necessary for epileptogenic focus localization and subsequent surgery in unilateral/bilateral MTS in this study. Seizure freedom in patients undergoing epilepsy surgery based on ictal SPECT assistance was comparable to the surgical group not requiring ictal SPECT.

Topics: Adolescent; Adult; Child; Clinical Decision-Making; Cysteine; Electroencephalography; Epilepsy; Female; Humans; Magnetic Resonance Imaging; Male; Organotechnetium Compounds; Postoperative Period; Retrospective Studies; Seizures; Tomography, Emission-Computed, Single-Photon; Young Adult

Immunomodulatory therapy has shown some therapeutic benefits in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. In this report, we describe the use of adrenocorticotropic hormone (ACTH) immunotherapy with good outcome in a patient with anti-NMDAR encephalitis.. A 4-year-old girl developed convulsions in her right arm and leg without impaired consciousness. These convulsions occurred frequently in clusters of 10-20 events of 10-20 s duration. She was admitted to our hospital on the 6th day following her initial series of convulsions. Flaccid paralysis of the right hand and leg was also found. Interictal electroencephalography showed high-amplitude slow waves. No abnormal findings were shown on MRI.. ACTH immunotherapy may be a useful treatment option for patients with anti-NMDAR encephalitis, although further evaluation is required.

Topics: Adrenocorticotropic Hormone; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Child, Preschool; Cysteine; Electroencephalography; Female; Humans; Organotechnetium Compounds; Radiopharmaceuticals; Seizures; Tomography, Emission-Computed, Single-Photon

A 68-year-old man with diabetes mellitus type 2 presented himself with visual distortion and apraxia. Nonketotic hyperglycemic seizure with both motor and sensory components was suspected. Tc-ECD perfusion SPECT demonstrated hyperperfusion at right parieto-occipital lobe during ictal phase. Normalization of hyperperfused area was noted on follow-up perfusion SPECT after intense glucose control. In nonketotic hyperglycemic state, the depletion of GABA in cerebral neurons lowers the seizure threshold. We demonstrated that ictal phase perfusion SPECT contributed to not only diagnosis but also served as a follow-up tool.

Topics: Aged; Cysteine; Humans; Hyperglycemia; Male; Occipital Lobe; Organotechnetium Compounds; Parietal Lobe; Perfusion Imaging; Radiopharmaceuticals; Seizures; Tomography, Emission-Computed, Single-Photon

Epileptic seizures are network-level phenomena. Hence, epilepsy may be regarded as a circuit-level disorder that cannot be understood outside this context. Better insight into the effective connectivity of the seizure onset zone and the manner in which seizure activity spreads could lead to specifically-tailored therapies for epilepsy. We applied the electrical amygdala kindling model in two rhesus monkeys until these animals displayed consistent stage IV seizures. At this stage, we investigated the effective connectivity of the amygdala by means of electrical microstimulation during fMRI (EM-fMRI). In addition, we imaged changes in perfusion during a seizure using ictal SPECT perfusion imaging. The spatial overlap between the connectivity network and the ictal perfusion network was assessed both at the regional level, by calculating Dice coefficients using anatomically defined regions of interest, and at the voxel level. The kindled amygdala was extensively connected to bilateral cortical and subcortical structures, which in many cases were connected multisynaptically to the amygdala. At the regional level, the spatial extents of many of these fMRI activations and deactivations corresponded to the respective increases and decreases in perfusion imaged during a stage IV seizure. At the voxel level, however, some regions showed residual seizure-specific activity (not overlapping with the EM-fMRI activations) or fMRI-specific activation (not overlapping with the ictal SPECT activations), indicating that frequently, only a part of a region anatomically connected to the seizure onset zone participated in seizure propagation. Thus, EM-fMRI in the amygdala of electrically-kindled monkeys reveals widespread areas that are often connected multisynaptically to the seizure focus. Seizure activity appears to spread, to a large extent, via these connected areas.. •Amygdala kindling in rhesus monkeys models epileptogenesis in MTLE•Interictal EM-fMRI reveals the network connected to the kindled amygdala.•Ictal SPECT perfusion imaging shows the brain network during seizures.•The perfusion changes partially overlap with the connected areas.•Seizure activity appears to spread, to a large extent, via these connected areas.

Topics: Amygdala; Animals; Brain; Brain Mapping; Cysteine; Disease Models, Animal; Electric Stimulation; Electroencephalography; Image Processing, Computer-Assisted; Kindling, Neurologic; Macaca mulatta; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Neural Pathways; Organotechnetium Compounds; Oxygen; Seizures; Tomography, Emission-Computed, Single-Photon

Extratemporal lobe epilepsy is difficult to localize. We aimed to define the best parameter(s) of SPECT for confirmation of seizure origin among the region of maximum cerebral perfusion in ictal phase (MP), maximum change of cerebral perfusion from interictal to ictal phase (MC), and maximum extent of hyperperfusion in ictal phase (ME) of (99m)Tc ECD brain perfusion SPECT as well as combined SPECT parameters, and combined SPECT and MRI for seizure localization in extratemporal lobe epilepsy.. Twenty intractable extratemporal lobe epilepsy patients who had (99m)Tc-ECD brain SPECT were reviewed. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of single SPECT parameter, combined SPECT parameters, and combined SPECT and MRI parameters for localization of seizure origin were calculated using pathology and surgical outcomes (Engel class I and II) as gold standards.. Combined SPECT parameters provided more specificity, PPV and accuracy than single SPECT parameters. The best combined SPECT parameters was MP+MC with 80.6 % accuracy, 92.4 % specificity and 43.8 % PPV. Combination of SPECT parameter with MRI (ME+MRI) was the most sensitive (41.7 %), specific (97.5 %), accurate (88.2 %) parameter and had highest PPV (76.9 %) and NPV (89.3 %) for seizure localization. It improved specificity and PPV when compared to MRI alone.. Combined SPECT parameters improved the specificity and accuracy in seizure localization. The most specific and accurate SPECT combination is MP+MC. The combined SPECT parameter with MRI further improved sensitivity, specificity, accuracy, PPV and NPV. The authors recommend using SPECT combination, MP+MC, when MRI is negative and ME+MRI when there is MRI lesion.

Topics: Adolescent; Adult; Brain; Child; Child, Preschool; Cysteine; Epilepsies, Partial; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Multimodal Imaging; Organotechnetium Compounds; Preoperative Period; Radiopharmaceuticals; Retrospective Studies; Seizures; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Young Adult

Amygdala kindling is a widely used animal model for studying mesial temporal lobe epileptogenesis. In the macaque monkey, electrical amygdala kindling develops slowly and provides an opportunity for investigating ictal perfusion changes during epileptogenesis.. Two rhesus monkeys were electrically kindled through chronically implanted electrodes in the right amygdala over a period of 16 and 17 months. Ictal perfusion single photon emission computed tomography (SPECT) imaging was performed during each of the four predefined clinical stages.. Afterdischarge duration increased slowly over 477 days for monkey K and 515 days for monkey S (18 ± 8 s in stage I; 52 ± 13 s in stage IV). During this time, the animals progressed through four clinical stages ranging from interrupting ongoing behavior to bilateral convulsions. Ictal SPECT perfusion imaging showed well-localized but widely distributed regions of hyperperfusion and hypoperfusion, in both cortical and subcortical structures, at every seizure stage. A large portion of the ictal network was involved in the early stages of epileptogenesis and subsequently expanded over time as seizure severity evolved.. Our data indicate that the different mesial temporal lobe seizure types occur within a common network affecting several parts of the brain, and that seizure severity may be determined by seizure-induced epileptogenesis within a bihemispheric network that is implicated from the start of the process.

Topics: Amygdala; Animals; Cerebrovascular Circulation; Cysteine; Disease Models, Animal; Electric Stimulation; Electroencephalography; Kindling, Neurologic; Macaca mulatta; Male; Organotechnetium Compounds; Perfusion; Radiopharmaceuticals; Seizures; Tomography, Emission-Computed, Single-Photon

An early 60s-year-old man suffered reversible dysfunction of the blood-brain barrier (BBB) induced by repeated injection of contrast medium during coil embolization of intracranial unruptured aneurysm. He presented with convulsion during coil embolization, and neurological symptoms of aphasia and right hemiparesis continued for 5 days, and then improved completely. All transient radiological abnormalities were limited to the territory of the left internal carotid artery, where contrast medium was injected repeatedly. Repeated computed tomography, magnetic resonance imaging, single-photon emission computed tomography, and cerebrospinal fluid test findings indicated that temporary dysfunction of the BBB might have occurred. Dysfunction of the BBB in the anterior circulation induced by contrast medium is rare. Tolerance to toxicity of contrast medium may depend on the individual patient, and repeated injection of contrast medium may cause dysfunction of the BBB, leading to toxic dysfunction directly in the brain.

Topics: Aphasia; Blood-Brain Barrier; Carotid Artery, Internal; Cerebral Angiography; Contrast Media; Cysteine; Dose-Response Relationship, Drug; Embolization, Therapeutic; Humans; Injections, Intra-Arterial; Intracranial Aneurysm; Iopamidol; Magnetic Resonance Angiography; Male; Middle Aged; Organotechnetium Compounds; Paresis; Seizures; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

We report a case of a patient with singing seizures, who was able to sing familiar songs by syllable name with no earlier practice. The patient was a 56-year-old musically naive woman who developed singing seizures when she was in her early 20s. She suddenly began singing familiar sacred songs by syllable name, even though she had never practiced the songs using a musical score or had earlier sung them by syllable name. An electroencephalogram showed bilateral low-voltage spikes that were significantly pronounced in the right temporal lobe. Technetium-99m-bicisate ethyl cysteinate dimer single photon emission computed tomography also showed hypoperfusion in the medial right temporal lobe. The right temporal lobe may be involved in singing, and there may be an automatic and unconscious analytical system of music perception that arranges each tone into its syllable name.

Topics: Auditory Perception; Brain; Cysteine; Electroencephalography; Female; Humans; Language; Middle Aged; Music; Organotechnetium Compounds; Radiopharmaceuticals; Seizures; Tomography, Emission-Computed, Single-Photon

Epileptic nystagmus (EN) describes repetitive eye movements that result from seizure activity. We describe a patient with EN and vertigo first noted at the age of 4 yr and 10 mo. Brain MRI did not show anomalies. Ictal EEG recordings revealed epileptic activity during three episodes of horizontal, left-beating nystagmus not crossing the midline. Ictal 99mTc-ECD SPECT demonstrated the presence of active foci in multiple cerebral regions including bilateral prefrontal, bilateral parieto-temporo-occipital and the left parieto-insular-vestibular areas. A wide area of hypoperfusion was also evident in the right hemisphere, prevailing in the parieto-occipital regions and the medial prefrontal gyrus. Topiramate was started at a dose of 2 mg/kg/d with complete seizure control after 14 d. EEG and SPECT were repeated after a seizure-free period of 1 mo; disappearance of epileptic activity and modification of cerebral perfusion were evident. This case reaffirms the cortical origin and involvement of temporo-occipital and frontal cortex in the genesis of saccadic epileptic nystagmus. Rapid complete control of clinical events coincided with the normalization of EEG and improvement of the SPECT pattern.

Topics: Brain; Cerebral Cortex; Child, Preschool; Cysteine; Electroencephalography; Epilepsies, Partial; Humans; Male; Neurologic Examination; Nystagmus, Pathologic; Organotechnetium Compounds; Radiopharmaceuticals; Seizures; Tomography, Emission-Computed, Single-Photon; Vertigo; Vision Tests

A 27-year-old man had complex partial seizures and a dysembryoplastic neuroepithelial tumor (DNT) in the left inferior-basal temporal region. The patient's seizures consisted of incomprehensible speech, staring, unresponsiveness, fumbling and then looking around. For the brain SPECT study, radiotracer was injected during the preictal (11s prior to seizure onset), ictal (at 25 s out of 47 s seizure duration) and interictal periods. Interictal SPECT was subtracted from preictal or ictal-injection SPECTs and then the subtracted SPECTs were overlaid on the patient's MRI (SISCOM). SISCOM with preictal-injection SPECT showed hyperperfusion at the brain lesion, whereas SISCOM with ictal-injection SPECT showed hyperperfusion at the ipsilateral amygdala-hippocampus and hypoperfusion around the tumor lesion. After the DNT and nearby temporal lobe tissues were resected with preservation of amygdala-hippocampus, the patient became seizure free without complaint of subjective postsurgical memory decline. In this patient, SISCOM with preictal injection of radiotracer localized an epileptogenic zone, whereas SISCOM with the ictal injection showed hyperperfusion at the symptomatogenic zone.

Topics: Adult; Brain Neoplasms; Cerebrovascular Circulation; Cysteine; Epilepsies, Partial; Humans; Magnetic Resonance Imaging; Male; Neoplasms, Neuroepithelial; Organotechnetium Compounds; Radiopharmaceuticals; Seizures; Tomography, Emission-Computed, Single-Photon

We report a patient manifesting seizures with bilateral symmetric tonic posturing, which were markedly reduced after resection of the left precuneus. A 16-year-old man had sudden onset, complex partial seizures with bilateral symmetric tonic posturing since the age of eight years. Magnetic resonance fluid-attenuated inversion-recovery imaging revealed a hyperintense lesion in left precuneus. In almost all focal seizures recorded during an invasive EEG evaluation, ictal onset was detected from the inferomesial aspect of the lesion, but fast paroxysmal discharges from the ipsilateral supplementary motor area (SMA) were observed just before the clinical onset. After surgical excision of the EEG onset zone, including the lesion, seizure frequency was markedly (> 95%) reduced. By the 20th month after surgery, there were only brief nocturnal seizures involving slight elevation of both shoulders and slight abduction of both arms, with preservation of consciousness occurring once every few days. Invasive EEG findings and surgical outcome suggested that the epileptic activity originating from the epileptogenic zone may have propagated to the symptomatogenic zone including mainly the ipsilateral SMA. In summary, we report an interesting case of bilateral symmetric tonic posturing suggesting propagation to the SMA. MRI and invasive EEG confirmed the epileptogenic focus as a precuneate cortical dysplasia lesion.[Published with video sequences].

Topics: Adolescent; Cerebral Cortex; Cysteine; Electroencephalography; Epilepsy, Generalized; Humans; Magnetic Resonance Imaging; Male; Motor Cortex; Neurosurgical Procedures; Organotechnetium Compounds; Parietal Lobe; Posture; Radiopharmaceuticals; Seizures; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Ictal single-photon emission computed tomography (SPECT) may help localize the seizure-onset zone (SOZ) by detecting changes in regional cerebral blood flow induced by epileptic discharges. This imaging method also reveals hyperperfusions in areas of seizure propagation, including the hemisphere contralateral to the SOZ. We have studied the occurrence, the topography, and the clinical value of such contralateral ictal hyperperfusion areas (HPAs).. We examined data from presurgical evaluations of 36 consecutive patients with pharmacoresistant partial epilepsy of various localizations. Ictal and interictal SPECT examinations were made with 99mTc-ECD, and the scans were processed for coregistration, normalization, subtraction, and merging with MRI images.. Contralateral HPAs were observed in 72% of the patients: 50% of mesiotemporal epilepsy cases with hippocampal sclerosis, 85.7% of the other mesiotemporal epilepsies, 85.7% of neocortical lateral temporal epilepsies, and 87.5% of extratemporal epilepsies. Contralateral HPAs were usually symmetrical to the SOZ, forming a mirror image, observed in 57.1% of the patients. They could be slightly asymmetrical in mesiotemporal epilepsies, perhaps because of the particular anatomic pathways linking temporal lobes. In neocortical epilepsies, they were located in the cortex homotopic to the SOZ.. We show that the symmetrical nature of the mirror image usually does not disturb SPECT interpretation. It can confirm the location of the SOZ (11 patients) and even occasionally improve the precision of its definition (nine patients) by restraining several potential SOZ-related HPAs to a single one or by permitting a restricted localization of the SOZ in a large HPA.

Topics: Brain; Brain Mapping; Cysteine; Electroencephalography; Epilepsy; Epilepsy, Temporal Lobe; Follow-Up Studies; Functional Laterality; Hippocampus; Humans; Magnetic Resonance Imaging; Neural Pathways; Organotechnetium Compounds; Preoperative Care; Regional Blood Flow; Retrospective Studies; Sclerosis; Seizures; Temporal Lobe; Tomography, Emission-Computed, Single-Photon; Videotape Recording

The cerebral representation of laughter is dissociated. The emotional aspects seem to be processed in the temporal lobe; whereas the motor features apparently rely on the frontal cortex. In a few prior studies of patients in whom laughter was elicited by electrical stimulation (ES), it always was associated with mirth. We report a patient in whom ES in the right cingulate gyrus elicited smile and laughter, but no mirth. At low voltages, smiling was seen first contralaterally and became bilateral with increasing currents. Our observation supports the concept of the motor representation of laughter in the mesial frontal cortex.

Topics: Adult; Brain Mapping; Cerebral Cortex; Cysteine; Electric Stimulation; Electrodes, Implanted; Electroencephalography; Fluorodeoxyglucose F18; Frontal Lobe; Functional Laterality; Gyrus Cinguli; Humans; Imaging, Three-Dimensional; Laughter; Male; Models, Neurological; Organotechnetium Compounds; Positron-Emission Tomography; Seizures; Smiling; Tomography, Emission-Computed, Single-Photon

Topics: Adult; Brain Mapping; Cysteine; Female; Humans; Image Enhancement; Magnetic Resonance Imaging; Organotechnetium Compounds; Radiopharmaceuticals; Seizures; Sturge-Weber Syndrome; Subtraction Technique; Tomography, Emission-Computed, Single-Photon

Focal cortical dysplasia is one of the known neuronal migration disorders and has recently been recognized as a cause of intractable epilepsy. In this study, we assessed the 11C-methionine (MET) uptake in focal cortical dysplasia by PET, and then compared the results with that of 18F-fluoro-2-deoxy-D-glucose (FDG) PET and 99mTc-ethyl cysteinate dimer (ECD) SPECT.. Four patients (3 men, 1 woman; age range 16-68 yr) were examined by PET and SPECT for a presurgical examination of medically intractable seizures. In all 4 patients, 11C-MET PET was performed for 15 min, started 15 min after the administration of 511-662 MBq MET. In 3 of 4 patients, FDG PET was performed for 15 min, and started 20 min after the administration of 185-370 MBq FDG. In all 4 patients, the cerebral blood flow was also evaluated by 99mTc-ECD SPECT for 15 min after the administration of 600 MBq ECD.. In MET PET, all 4 lesions were visually recognized to have high MET uptake areas. The MET uptake of the lesions was 1.44 +/- 0.30 for the standardized uptake value (SUV) (ranging from 0.99-1.61). In FDG PET, 2 lesions were demonstrated to have low uptake areas (3.82 in SUV) while 1 had an ictal high uptake (4.74 in SUV). In ECD SPECT, 1 lesion demonstrated hypoperfusion and 1 ictal hyperperfusion while 2 showed no abnormalities. All 4 patients underwent a cortical resection and the microscopic examinations were consistent with those of focal cortical dysplasia but no evidence of a tumor was found.. MET PET is useful for identifying focal cortical dysplasia as a high uptake area.

Topics: Adolescent; Adult; Aged; Cerebral Cortex; Cerebrovascular Circulation; Cysteine; Epilepsy; Female; Fluorodeoxyglucose F18; Humans; Magnetic Resonance Imaging; Male; Methionine; Organotechnetium Compounds; Radiopharmaceuticals; Seizures; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

The purpose of this study was to assess the normal perfusion pattern of the pediatric brain with 99mTc-ethylcysteinate dimer (99mTc-ECD).. Tomographic imaging was performed with a dedicated system with high sensitivity and resolution. Sixteen children, referred for brain imaging in the workup of seizure disorder, were included since they turned out negative after a 1-yr follow-up. A standardized brain presentation was obtained after reslicing and reorienting of the three-dimensional volumetric dataset.. Quantitative analysis did not reveal significant left-right uptake differences per patient. Three age clusters were investigated that showed differences in regional uptake, mainly a relatively increased uptake in basal ganglia, visual and motor cortex. An uptake ratio or perfusion index was calculated after normalization. Normal limits were established for the children in the three groups.. Technetium-99m-ECD is a safe agent for children and should be the radiopharmaceutical of choice for brain perfusion studies because of favorable radiation dosimetry and stability. The age dependence of perfusion necessitates a database comparison before concluding that the observed perfusion pattern is normal.

Topics: Adolescent; Brain; Cerebrovascular Circulation; Child; Child, Preschool; Cysteine; Female; Humans; Infant; Male; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Reference Values; Seizures; Sensitivity and Specificity

Forty-one ECD (Technetium-99m-ethyl cysteinate dimer) SPECT investigations were undertaken in the course of a presurgical diagnostic work-up in 23 patients with pharmacoresistant focal epilepsy. In 21 patients, both an ictal and interictal SPECT were conducted. In the patients receiving ictal SPECT the tracer was injected between 7 and 30 s after the seizure onset. Of the interictal SPECTs 17 of 23 showed focal hypoperfusion which was consistent in 17 cases (74%) with the area of the electrophysiological focus (EF) and 6 patients had a normal interictal SPECT. Of the ictal SPECTs 18 of 21 (86%) showed regional hyperperfusion, 18 of them in the same location as the EF. Ictal SPECT showed a hypoperfusion similar to that in interictal SPECT in another 3 patients. In these cases seizure duration was short (28-54 s), so that the tracer reached the brain postictally. Our results show that ictal ECD-SPECT is an effective method for demonstrating an epileptogenic focus. Possible reasons for false-negative ictal SPECT results are discussed.

Topics: Adolescent; Adult; Blood Flow Velocity; Brain; Brain Mapping; Cerebral Cortex; Child; Cysteine; Electroencephalography; Epilepsy; Female; Humans; Male; Middle Aged; Monitoring, Physiologic; Organotechnetium Compounds; Radiopharmaceuticals; Regional Blood Flow; Seizures; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon