Single photon emission computed tomography (SPECT) with N-isopropyl-p-(123I) iodoamphetamine in partial epilepsy

Thirty eight patients with partial seizures in the interictal phase were studied using single photon emission computed tomography performed 30 min. (early image) and 4∼4.5 hrs. (delayed image) after an injection of 111 MBq (3 mCi) N-isopropyl-p-(123I)iodoamphetamine (IMP). Five types of distribution changes were observed on IMP-SPECT between the early and delayed images. Eight patients, Type 1, exhibited an unchanged distribution of IMP between the early and delayed images. Fifteen patients, Type 2, showed a smaller area of low uptake on the IMP-SPECT (delayed image) compared to that on the IMP-SPECT (early image)-redistribution. The Type 3 patients exhibited an initial uptake area on the IMP-SPECT (early image) which later became a lower uptake area on the IMP-SPECT (delayed image)-reversed redistribution. This type was further classified into three categories according to the initial uptake pattern including (a) Type 3A, 3 patients with increased uptake area, (b) Type 3B, 6 patients with normal uptake area, and (c) Type 3C, 6 patients with decreased uptake area. With Type 2, the epileptic findings on the present interictal electroencephalogrpahy (EEG) were shown in 11 of 15 patients. However, we could not find any other remarkable correlation among these 5 types and the clinical factors (the types of seizures, the X-CT findings, the present interictal EEG data, the present frequency of seizures, and the intervals from the last seizure). In 2 patients with Type 3B who suffered from simple partial seizures, a region of the normal distribution on the IMP-SPECT (early image) became a lower uptake area on the IMP-SPECT (delayed image), corresponding topologically to the ictal symptoms. In this experience, we determined that the IMP-SPECT (delayed image) could be useful in patients with the epileptic lesions unable to be detected on the IMP-SPECT (early image). (author)