Mapping the sparks: Combined ictal and interictal Tc-99m ECD SPECT in frontal lobe epilepsy diagnosis

Epilepsy, one of the most prevalent neurological disorders, does not sufficiently respond to pharmacological treatment in a significant proportion of the patients. Surgical resection of the epileptogenic zone offers a high chance of cure for individuals with drug refractory epilepsy. This requires accurate localization of the epileptogenic zone prior to surgery. If one of the conventional pointers to the epileptogenic zone assessed during presurgical evaluation (MRI and electroencephalography) is absent, or if there is discrepancy between these pointers, more sophisticated imaging is needed. Thus, ictal and interictal brain perfusion single-photon emission computed tomography (SPECT) helps, especially in frontal lobe epilepsy (FLE) which is often difficult to diagnose. This case underscores the utility of combined ictal and interictal Tc-99m ECD SPECT when the conventional modalities are inconclusive, thereby helping in localizing the epileptogenic focus and further management of the patient