Do the results of ictal SPECT add value beyond what is already learned by ictal scalp EEG and MRI?

Presenter: Aliza Sharon Kumpinsky, M.D.

Link to PowerPoint Presentation:  SPECT 3.3 edited

Clinical Question:

Do the results of ictal SPECT add value beyond what is already learned by ictal scalp EEG and MRI?   Will it change management?

Journal Club Article:

Velasko TR, et al.  Utility of ictal single photon emission computed tomography in mesial temporal lobe epilepsy withhippocampal atrophy: a randomized trial.  Neurosurgery. 2011 Feb;68(2):431-6: Utility of Ictal SPECT in MTLE with Hippocampal Atrophy

Methodology:

MTLE patients were randomly assigned to those with (SPECT, n = 124) and
without ictal SPECT (non-SPECT, n = 116) in an intent-to-treat protocol. Primary end
points were the proportion of patients with invasive EEG studies, and those offered
surgery. Secondary end points were the length of hospital stay and the proportion of
patients with secondarily generalized seizures (SGS) during video-EEG, postsurgical
seizure outcome, and hospital cost.

Study Conclusions:

Ictal-SPECT did not add localizing value beyond what was provided by
EEG-video telemetry and structural MRI that altered the surgical decision and outcome
for MTLE-HS patients. Ictal-SPECT increased hospital stay was associated with increased
costs and a higher chance of SGS during video-EEG monitoring. These findings support
the notion that a protocol including ictal SPECT is equivalent to one without SPECT in the
presurgical evaluation of adult patients with MTLE-HS.