Use of Innovative SPECT Techniques in the Presurgical Evaluation of Patients with Nonlesional Extratemporal Drug-Resistant Epilepsy

Figure 2

Ictal and interictal SPECT scans in a three-year-old boy with drug-resistant epilepsy. (a) Interictal SPECT showed prominent hypoperfusion over the left frontotemporal region. (b) First ictal SPECT attempt was performed in a seizure of 46-second duration, and radioisotope was injected at 40 seconds from the seizure onset. This was a late injection, and ictal SPECT showed similar findings as to the interictal SPECT. (c) Repeated ictal SPECT attempt was performed in a seizure of nine-second duration, and radioisotope was injected at two seconds from the seizure onset. This was an early injection, and ictal SPECT showed a relative increase in perfusion in the left frontotemporal region, compared with the right. This demonstrates the significance of early injection in accurately localizing the seizure onset zone, adapted from Kim et al. [38].