[Peri-ictal SPECT in temporal lobe epilepsy: post-surgical evaluation]

INTRODUCTION

our aim was to evaluate the usefulness of peri-ictal SPECT in localising the epileptogenic region (ER) in candidates for temporal lobectomy to treat medically refractory complex partial seizures (CPS). Interictal and ictal SPECT, MRI and video-EEG results were compared and the positive predictive value (PPV) was calculated in those patients with good surgical outcome.

MATERIALS AND METHODS

37 patients who had a minimum of 3 years follow-up after surgery were studied retrospectively. Pre-surgical evaluation had included video-EEG monitoring, MRI and interictal and ictal SPECT. These results were compared to the surgically treated ER and successful outcome confirmed by post-surgical clinical follow-up. 29/37 patients remained seizure-free in the post-surgical follow-up. Interictal and peri-ictal SPECT were performed using 740 MBq of 99mTc-HMPAO. Peri-ictal SPECT was ictal in 25 patients and postictal in 12.

RESULTS

ER concordance with video-EEG and peri-ictal SPECT was 86% (32/37 patients). It was 84% (31/37) for MRI and 54% (20/37 patients) for interictal SPECT. Peri-ictal SPECT localised the ER in 8/11 patients with discordant MRI and video-EEG results. Ictal SPECT localised the ER in the correct temporal lobe in 23/25 patients (92% concordance). In the 29 patients with a good surgical outcome, the PPV of video-EEG was 95% (27/29) and it was 90% (26/29) for both MRI and peri-ictal SPECT.

CONCLUSIONS

peri-ictal brain SPECT is well able to localize ER in patients with temporal lobe epilepsy. Periictal SPECT concordance with ER was as good as video-EEG and MRI and its PPV was as good as that of MRI. We strongly recommend its use in the pre-surgical evaluation of temporal lobe epilepsy, especially when MRI and EEG are discordant.

[Psychiatric disorders, personality and traumatic experiences in conversive non-epileptic seizures patients]

AIM

To study the clinical characteristics in patients with conversion non-epileptic seizures, and the influence that traumatic childhood experiences could have in their psychopathologic status and personality.

METHODS

Seventeen patients with non-epileptic seizures confirmed through video-EEG were included. A structured clinical interview (SCID-DSM-III-R), a measure of personality variables (MMPI), and an interview designed for collecting data on personal history of childhood traumas were administered. Descriptive and comparative statistical methods were used.

RESULTS

More than 70% of the sample fulfilled the criteria for two or more simultaneous diagnoses in Axis I, and for at least one personality disorder. The subgroup experiencing childhood traumatic experiences showed more clinically significant MMPI scales, a younger age at correct diagnosis, and higher scores on the MMPI psychastenia and psychopathic deviation scales than the non experiencing childhood traumatics events.

CONCLUSIONS

Our sample of patients with conversion non-epileptic seizures shows a significant level of psychopathology, and the absence of a unique character substrate. Under the generic term of pseudoseizures, a number of subgroups according to childhood traumatic experiences, with different levels of severity and different clinical and personality properties, may be defined.