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. 2021 Dec;144(6):687-694.
doi: 10.1111/ane.13515. Epub 2021 Aug 14.

Functional neuroimaging in nonepileptiform electroencephalographic patterns in status epilepticus

Albert Muñoz-Vendrell  1 , Jacint Sala-Padró  1 , Sonia Jaraba  1   2 , Gabriel Reynés-Llompart  3   4 , Misericòrdia Veciana  5 , Jaume Mora  4 , Mercè Falip  1
Affiliations

Functional neuroimaging in nonepileptiform electroencephalographic patterns in status epilepticus

Albert Muñoz-Vendrell et al. Acta Neurol Scand. 2021 Dec.

Abstract

Background: The diagnosis of nonconvulsive status epilepticus (NCSE) in patients with nonepileptiform EEG patterns remains a challenge.

Objective: To evaluate the usefulness of single photon emission computerized tomography (SPECT) and its quantification (QtSPECT) in the diagnosis of NCSE.

Methods: We retrospectively reviewed patients admitted with clinical suspicion of NCSE who underwent an HMPAO-SPECT simultaneously with scalp EEG showing nonepileptiform patterns, in a 5-year period. After a complete diagnostic workup, treatment, and clinical evolution, disregarding the SPECT results, patients were classified into confirmed NCSE (n = 11) and non-NCSE (n = 8). Then, we compared the EEG and SPECT results in both groups.

Results: Lateralized rhythmic delta activity (LRDA) was predominant in the NCSE group (45.4%, p = .045), while lateralized irregular slowing was observed equally in both groups. Patients with NCSE showed significant hyperperfusion compared with non-NCSE patients (p = .026). QtSPECT correctly classified 91% of patients in NCSE and 75% patients with non-NCSE (p = .006).

Conclusions: Regional cerebral blood flow measured with SPECT could be useful in the diagnosis of NCSE in cases of an EEG pattern with lateralized slow activity and high clinical suspicion.

Keywords: SPECT; ictal-interictal continuum; lateralized rhythmic delta activity; nonconvulsive status epilepticus; quantified SPECT.

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References

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