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Inhibitory effects of mesial temporal partial seizures onto frontal neocortical structures.

PURPOSE
A retrospective evaluation of the ictal temporal tracer uptake and the perfusion pattern in other neo- and subcortical structures was performed to define typical extratemporal changes of rCBF that might further aid the differentiation of temporal and extratemporal seizures.


METHOD
Ictal and interictal rCBF brain SPECT studies were done in 17 patients with seizures of mesial temporal onset according to scalp electroencephalography (EEG) and electrocorticography (ECoG) using 99mTc-ECD. Except for hippocampal sclerosis/atrophy, which was found in 11/17 patients, no morphologic anomalies were detected by MRI. Ictal tracer injections were given immediately after the onset of the seizure according to continuous video-EEG monitoring. The injection latency was two to twenty seconds. The data acquisition was done 45 minutes after the tracer injection using an annular crystal system (Ceraspect, DSI). In 15 patients a semiquantitative ROI-analysis of the tracer uptake in temporal and frontal regions could be obtained.


RESULTS
All ictal studies correctly localised the affected temporal lobe. A detection of the epileptogenic focus itself was successful in 59% of patients while in the remaining patients the maximum of tracer uptake was not found to be located in the mesial temporal lobe only. In contrast to all other cerebral structures, only within the ipsilateral basal frontal cortex a frequent reaction to the temporal seizure was found. The basal frontal cortex ipsilateral to the affected temporal lobe showed a reduction of tracer uptake between the ictal and interictal study in 82% of patients which was semiquantitatively significant using a paired t-test (p < 0.05). Other neo- or subcortical structures showed inconsistent results.


CONCLUSION
Secondary involvement of neocortical temporal structures in ictal rCBF-SPECT with 99mTc-ECD occurs early and focal maxima of tracer uptake within the temporal lobe do not necessarily represent the epileptogenic focus itself. Seizures of mesial temporal origin did not activate but frequently depressed the ipsilateral basal frontal tracer uptake during the early ictal phase. This phenomenon may account for some aspects of the clinical appearance of mesial temporal seizures.