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KMID : 0877220030070010016
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Journal of Korean Epilepsy Society
2003 Volume.7 No. 1 p.16 ~ p.26
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Regional Cerebral Blood Flow Patterns in Unilateral Mesial Temporal Lobe Epilepsy：Statistical Parametric Mapping of Ictal and Interictal SPECT
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Tae Woo-Suk
Joo Eun-Yeon
Kim Jee-Hyun
Seo Dae-Won
Hong Seung-Chyul
Lee Mun-Hyang
Kim Myoung-Hee
Hong Seung-Bong
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Abstract
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Purpose：To investigate the regional cerebral blood flow of pati-ents with mesial temporal lobe epilepsy (mTLE), we performed the statistical parametric mapping (SPM) analysis in patients with mTLE.
Methods：Nineteen normal subjects and 38 with mTLE (22 left, 16 right) underwent brain SPECT. For SPM analysis, all SPECT images were spatially normalized and then smoothed. The left and right mTLE groups were statistically compared with normal sub-jects, and the paired t-test was performed between ictal and inte-rictal SPECTs. The positive and negative contrasts displayed the regions of hypo- or hyper-perfusion, respectively. The significance level was set to false discovery rate corrected p<0.05.
Results：In the interictal state, the ipsilateral hippocampus, both thalami, pericentral gyri, left insula, and both medial frontal lobes showed hypoperfusion, whereas both posterior lateral temporal ar-eas showed hyperperfusion. In the ictal state, the rCBF of ipsilateral temporal lobe to the epileptic focus and both prefrontal white ma-tters increased, while both medial frontal lobes showed hypoper-fusion. In the right mTLE, the left hippocampus and insula showed hypoperfusion during the interictal state. In the paired t-test, ipsila-teral temporal lobe, hippocampus, thalamus, putamen, insula, and both precentral gyri showed hyperperfusion.
Conclusions：Surprisingly, the hypoperfusion and hyperperfu-sion patterns of patients with mTLE were similar both in the interictal and ictal states. These findings indicate that the occurrence and propagation of epileptic discharges happen not only in the ictal state but also during the interictal period. The hypoperfusion pat-terns suggest that the cortico-thalamo-hippocampal-insula circuit was impaired during the interictal state while temporal and pre-frontal regions showed hypofunction during the ictal period.
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KEYWORD
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Mesial temporal lobe epilepsy, SPECT·Hyper-perfusion, Hypoperfusion, Statistical parametric mapping
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