Single photon emission computerized tomography during and between seizures

Abstract

In three patients, patterns of brain activity were measured by 99mTc-hexamethyl-propyleneamineoxime (99mTc-HM-PAO) brain SPECT (single photon emission computerized tomography) in ictal and interictal states. Increased relative blood flow indicated the focus of partial seizures, its spreading to adjacent cortical regions and to distant brain structures via neuronal pathways. Ictal patterns of regional cerebral blood flow (rCBF) were in agreement with clinical symptomatology. Successive SPECT studies were performed after 3-7 days in the absence of electroencephalographic and clinical signs of seizures but still revealed increased relative blood flow in the focus of the seizures. SPECT studies, performed 2-6 weeks after the last clinically observable seizures, demonstrated the transition from increased to decreased relative blood flow in the focus of the seizures. In one patient, the EEG was complementary to and corresponded with the rCBF patterns in the ictal state. However, the dynamics of interictal changes could only be assessed by brain SPECT.