Ictal Ceretec studies - the Austin experience

Full text: Ictal Ceretec studies play a major role in the patient work-up for surgery of focal epilepsy in the Comprehensive Epilepsy Program at the Austin Hospital. The validity of ictal Ceretec and the superior sensitivity of this technique for the detection of epileptic foci over post-ictal and inter-ictal studies are well documented. Over the past eight years our experience and close collaboration with the Comprehensive Epilepsy Program has led to the implementation of a streamlined program enabling ictal Ceretec to be performed on numerous patients. The patients on this program since October 1991 will be reviewed and quality assurance (QA) results will be addressed. Ceretec is stored in a special lead-lined container in the video monitoring rooms, together with a shielded syringe of freshly eluted pre-calibrated technetium. Once a seizure is detected, the medical staff prepare the Ceretec and inject the required volume, obtained from the pre-calibration sheet, through a previously inserted in-dwelling line. The ward staff record the time of injection, the estimated duration of the seizure, the clinical impression of the seizure and the suspected focus. The injection tray is brought to the department within thirty minutes, where the patient injected dose is determined and quality control is performed. The scan is performed on a triple-headed Trionix gamma camera and reported once EEG and video recordings obtained during the ictus confirm the nature of the seizure. The advantages of this program are numerous. Many modifications have been made to the program over the past three years, due to close inspection of the QA forms. Ward and nuclear medicine staff deal with problems promptly, ensuring an effective and efficient program