SPECT activation patterns in psychogenic non-epileptic seizures in temporal lobe epilepsy patients
- Resource Type
- Authors
- Alejandro Scaramelli; Rodolfo Ferrando; Patricia Braga; Denisse Rada; Mariana Legnani; Andres Damian
- Source
- Seizure. 90:110-116
- Subject
- Adult
medicine.medical_specialty
Electroencephalography
Ictal-Interictal SPECT Analysis by SPM
Temporal lobe
03 medical and health sciences
Epilepsy
0302 clinical medicine
Seizures
Internal medicine
Psychogenic non-epileptic seizures
Humans
Medicine
Psychogenic disease
Ictal
Retrospective Studies
Tomography, Emission-Computed, Single-Photon
medicine.diagnostic_test
business.industry
General Medicine
medicine.disease
Magnetic Resonance Imaging
nervous system diseases
Epilepsy, Temporal Lobe
nervous system
Neurology
Case-Control Studies
Cardiology
Neurology (clinical)
Epileptic seizure
medicine.symptom
business
030217 neurology & neurosurgery
- Language
- ISSN
- 1059-1311
Introduction The diagnosis of psychogenic non-epileptic seizures (PNES) can often be challenging. When video-electroencephalography (EEG) is not conclusive, single-photon emission computed tomography (SPECT) can be useful by quantifying changes in regional cerebral blood flow (rCBF). Methods We conducted a retrospective case-control study in adult patients with pharmacoresistant temporal lobe epilepsy (TLE). Those patients with an ictal SPECT obtained during an event finally diagnosed as PNES were included as cases (PNES+). The control group consisted of patients with TLE without PNES (PNES-). Clinical episodes were analysed and classified according to PNES subtypes. Subtraction ictal SPECT coregistered to MRI (SISCOM) analysis was performed for the detection of areas with significant changes in perfusion compared to individual interictal studies. Group comparisons in SPM12 included paired t-tests of ictal vs. interictal studies in each group of temporal lobe seizures and PNES events. Results Ten patients with TLE and PNES were included. We found no patterns of regional hyperperfusion typical of TLE seizures during the PNES events. In two of these cases, an ictal SPECT during a confirmed epileptic seizure was also obtained, showing antero-mesial temporal lobe hyperperfusion. Group comparisons between ictal and interictal SPECTs showed increased rCBF in the temporal lobe with reduced perfusion in the default mode network areas and cerebellum during temporal lobe seizures in PNES- patients and decreased perfusion restricted to the posterior parietal cortex without significant rCBF increases in PNES events. Conclusions Ictal SPECT can be a helpful tool to characterize rCBF changes in PNES and for differential diagnosis with seizures in TLE patients.