측두엽 간질의 수술 전 검사에서 발작 중 99mTC-ECD SPECT의 유용성에 관한연구 -관규형태와 임상양상과의 연관성-
Usefulness of ICTAL 99mTC-ECD Brain SPECT for Pre-Surgical Evaluation in Temporal Lobe Epilepsy
강중구, 이상암, 마효일, 류진숙, 강도영, 이정교,
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강중구 ( Kang Joong-Koo )
울산대학교 의과대학 서울중앙병원 신경과학교실
이상암 ( Lee Sang-Ahm )
울산대학교 의과대학 서울중앙병원 신경과학교실
마효일 ( Ma Hyeo-Il )
한림대학교 의과대학 신경과학교실
류진숙 ( Ryu Jin-Sook )
울산대학교 의과대학 서울중앙병원 핵의학과
강도영 ( Kang Do-Young )
경북대학교 의과대학 핵의학교실
이정교 ( Lee Jung-Kyo )
울산대학교 의과대학 서울중앙병원 신경외과학교실
KMID : 0877219990030020180
Abstract
Purpose: We evaluated usefulness of ictal 99mTc-ECD SPECT in temporal lobe epilepsy (TLE) patients for per-surfical evaluation and also correlated ictal SPECT patterns with the semiology of seizures. We also investifated whether there are any differences in ictal SPECT pattern between temporal lobe seizures with or without secondary generalized tonic-clonic seizure (GTC).
Methods: ictal SPECT was performed in 26 TLE patients who had unlateral hippocampal atrophy (20 patients), other focal remporal lesions (4 patients), and normal MRI finding (2 patients). All patients underwent temporal lobectomy with a minimim 27 months follow-up with excellent post-surgical seizure outcome (Engel´s classification class I). During CCTV monitoring 99mTc-ECD was injected during ictal peroid in all patients with a mean delay of 37.5±13.3 sec after seizure onset (mean seizure duration : 99.3±38.0 sec). Ictal SPECT was visually analysed by two blinded observers.
Results: Ictal 99mTc-ECD SPECT showed unilateral temporal hyperperfusion concordant with epileptogenic foci in 25/26 (96.2%). The hyperperfusion of the ipsilateral basal ganglia was evident in 12/19 (63.2%) during contralateral (or predominantly contralateral) hand dystonic/ tonic posture. The contralateral cerebellar hyperperfusion was observed in the 6/26 (23.1%). Seizures with secondary GTC at the time of injection showed brainstem and bilateral thalamic hyperperfusion in 6/8 (75.0%) and seizures without secondary GTC at the time of injection showed brainstem and bilateral thalamic hyperperfusion in 2/18 (11.1%). There was significant difference between two groups (p<0.01).
Conclusion: L Ictal 99mTc-ECD SPECT is a useful method to localize the epileptic foci for pre-surfical evaluation and the hyperperfusion of bilateral thalamus and brainstem is significantly frequent during secondary generalization of temporal lobe seizure.
키워드
측두엽 간질;발작중 SPECT;임상양상;시상혈류증가;뇌간혈류증가
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