Abstract Details

Title Ictal Single Photon Emission Computed Tomography (SPECT) In Patients with Focal Aware Seizure without Ictal Electroencephalographic Changes: A Single Center Experience

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 9-012

Objective N/A

Background There is currently limited literature on the localization value of ictal SPECT tracer injection during patient-reported typical focal aware seizures (auras) that lack electrographic changes. One study reported that ictal SPECT studies in isolated auras lack reliability, with concordant localization with the seizure onset zone obtained in 5%, and lateralization in 35% of cases. In another study, localizing information of self-injection of ictal SPECT was better in three patients and obviated the need for intracranial monitoring in one patient. We present a study in which tracer injection was administered for patient-reported typical focal aware seizures, where the subsequent analysis of ictal and interictal SPECT helped inform further management.

Design/Methods We performed a retrospective review of cases who underwent ictal SPECT between 2020 to 2022 at University of Kentucky hospital. Cases with radiotracer injection during patient-reported auras lacking electrographic changes were identified. Timing of injection from onset of reported aura, hyperperfusion changes on ictal SPECT, and the outcome of imaging on further management of refractory epilepsy were noted.

Results 20 patients underwent ictal SPECT, of which 7 met our inclusion criteria. None of the 7 cases had electrographic correlate with aura on scalp EEG. Time of tracer injection ranged from 1- 17 seconds following onset of aura. The ictal SPECT changes correctly localized the seizure onset zone in five patients. This was followed by intracranial monitoring and subsequent temporal lobectomy in three patients, interventricular ablation of epileptogenic focus in one patient, and Responsive Neurostimulation implant in one patient. One patient was managed medically, and one is ongoing pre-surgical evaluation.

Conclusions Ictal SPECT with radiotracer injection during typical focal aware seizures (patient reported auras) without ictal electrographic changes is helpful in the localization of the seizure onset zone. Additional studies with larger sample size and outcome information are needed to assess accuracy of localization.

Authors/Disclosures
Saniya Pervin, MD (Work) PRESENTER	Dr. Pervin has nothing to disclose.
Subhan Khan, MD (University of Kentucky)	Dr. Khan has received personal compensation for serving as an employee of University of Kentucky.
Jordan L. Clay, MD (UK Healthcare)	Dr. Clay has nothing to disclose.
	No disclosure on file
	No disclosure on file
Sally V. Mathias, MD, FANA, FAES, FAAN (University of Kentucky, Department of Neurology)	Dr. Mathias has or had stock in Abbvie Inc.Dr. Mathias has received personal compensation in the range of $100,000-$499,999 for serving as a neurologist with Department of Veterans Affairs (VHA).

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