Correlation of MRI hippocampal volume analysis, video/EEG monitoring and inter- and postictal single photon emission tomography in refractory focal epilepsy

• Published in: Neuroradiology Vol. 36; no. 1; pp. 11 - 16
• Main Authors: MARTINEZ, M, SANTAMARIA, J, MERCADER, J. M, CATAFAU, A, CARDENAL, C, LOMENA, F
• Format: Journal Article
• Language: English
• Published: Berlin Springer 1994
• Subjects: Adolescent; Adult; Atrophy; Biological and medical sciences; Electroencephalography; Epilepsy, Complex Partial - diagnosis; Epilepsy, Complex Partial - diagnostic imaging; Epilepsy, Temporal Lobe - diagnosis; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Hippocampus - diagnostic imaging; Hippocampus - pathology; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Monitoring, Physiologic; Nervous system (semeiology, syndromes); Neurology; Prospective Studies; Tomography, Emission-Computed, Single-Photon; Radionuclide study; Human; Nervous system diseases; Epilepsy; Complex partial epilepsy; Exploration; Electroencephalography; Nuclear magnetic resonance imaging; Photon; Cerebral disorder; Electrodiagnosis; Central nervous system disease; Negative therapeutic reaction; Positron emission tomography; Comparative study; Hippocampus
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/BF00599185

The effectiveness of surgery in patients with refractory complex partial seizures depends on accurate localisation of the epileptogenic zone. To assess the correlation between magnetic resonance imaging (MRI) hippocampal volume measurements. Tc 99m-hexamethyl-propyleneamineoxime inter- and postictal single photon emission computed tomography (SPECT) and clinico-electrophysiological (video/EEG) localisation of the epileptogenic zone we prospectively studied 16 consecutive patients with refractory complex partial seizures and no significant abnormality on standard MRI. Each test was interpreted blindly by independent observers. Eight patients (50%) had asymmetrical hippocampal volumes indicative of unilateral atrophy; correlation with the video/EEG and postical SPECT changes was very high (100% with definitive video/EEG localisation, 75% with interictal EEG and 83% with postictal SPECT). Moreover, the left/right hippocampal ratio was able to differentiate temporal from extratemporal video/EEG localisations. Postictal SPECT showed regional lateralised changes in 9 (64%) of 14 technically satisfactory studies. Disagreement between the video/EEG and postictal SPECT was seen with two extratemporal and one bitemporal foci.