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Author Rathore, Chaturbhuj ♦ Kesavadas, C. ♦ Ajith, Joy ♦ Sasikala, Achikanath ♦ Sarma, Sankara ♦ Radhakrishnan, Kurupath
Source Sree Chitra Tirunal Institute for Medical Sciences & Technology
Content type Text
Publisher Seizure-european Journal of Epilepsy
File Format PDF
Language English
Subject Domain (in DDC) Technology ♦ Medicine & health ♦ Diseases
Subject Domain (in MeSH) Nervous System Diseases ♦ Diseases ♦ Surgical Procedures, Operative ♦ Analytical, Diagnostic and Therapeutic Techniques and Equipment
Subject Keyword Radiology
Abstract Purpose: To investigate the utility of single photon emission computed tomography (SPECT) without subtraction and MRI co-registration in decision making for epilepsy surgeryMethods: Patients with refractory epilepsy and nonlocalizing or discordant non-invasive data (clinical, long-term VEEG, and MRI) were subjected to interictal and ictal SPECT studies before planning invasive or surgical strategy. Final localization was based upon the preoperative information and seizure freedom after surgery. SPECT was considered to be useful for decision-making if it obviated the need for intracranial monitoring or influenced its planning.Results: 61 patients (mean age, 25.1 +/- 8.3 years) underwent SPECT studies between January 2004 and December 2008. Twenty-two patients had mesial temporal lobe epilepsy (MTLE), 13 had neocortical temporal lobe epilepsy (NTLE), and 26 had extratemporal lobe epilepsy (ETLE). As compared to ETLE, SPECT provided more localizing information (77.3% vs 46.2%, p = 0.006) and influenced the final decision-making (45.4% vs 11.53%, p = 0.005) in a significantly higher number of patients with MTLE. SPECT was particularly useful in patients with lesional TLE and nonlocalizing ictal data and in those with dual pathologies. SPECT did not provide any additional information in patients having either TLE or ETLE with normal MRI.Conclusions: SPECT is useful in a selected group of patients and unlikely to provide additional information in others. By restricting its use in patients who are likely to be benefited, a cost-effective utilization strategy can be employed in countries with limited resources. Due to the small number, these findings need to be validated in a larger group of patients. (C) 2010 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
Education Level UG and PG
Learning Resource Type Article
Educational Framework Medical Council of India (MCI)
Volume Number 20
Issue Number 2
Page Count 8
Starting Page 107
Ending Page 114