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Kasahara H, Sato M, Nagamine S, Makioka K, Tanaka K, Ikeda Y. Temporal Changes on 123I-Iomazenil and Cerebral Blood Flow Single-photon Emission Computed Tomography in a Patient with Anti-N-methyl-D-aspartate Receptor Encephalitis. Intern Med 2019; 58:1501-1505. [PMID: 30713292 PMCID: PMC6548939 DOI: 10.2169/internalmedicine.0987-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A 45-year-old man was admitted due to tonic seizures, aphasia, disturbance of consciousness, and abnormal behavior. Because cerebral magnetic resonance imaging findings were normal and mild cerebrospinal fluid (CSF) pleocytosis was observed, autoimmune encephalitis was suspected. The presence of anti-N-methyl-D-aspartate (NMDA) receptor antibodies in the CSF was subsequently confirmed. 123I-Iomazenil and cerebral blood flow single photon emission computed tomography (SPECT) revealed an abnormal uptake in the left frontotemporal region. Multimodal immunotherapy was administered, which remarkably improved the level of consciousness. Progressive reversibility of SPECT findings with clinical improvement suggested that the disorder-related functional deficits had been caused by anti-NMDA receptor antibodies.
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Affiliation(s)
- Hiroo Kasahara
- Department of Neurology, Gunma University Graduate School of Medicine, Japan
| | - Masayuki Sato
- Department of Neurology, Gunma University Graduate School of Medicine, Japan
| | - Shun Nagamine
- Department of Neurology, Gunma University Graduate School of Medicine, Japan
| | - Kouki Makioka
- Department of Neurology, Gunma University Graduate School of Medicine, Japan
| | - Keiko Tanaka
- Department of Animal Model Development, Brain Research Institute, Niigata University, Japan
| | - Yoshio Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, Japan
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Fujimoto A, Okanishi T, Kanai S, Sato K, Itamura S, Baba S, Nishimura M, Masui T, Enoki H. Double match of 18F-fluorodeoxyglucose-PET and iomazenil-SPECT improves outcomes of focus resection surgery. Acta Neurochir (Wien) 2018; 160:1875-1882. [PMID: 29858947 DOI: 10.1007/s00701-018-3573-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 05/23/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND When the results of electroencephalography (EEG), magnetic resonance imaging (MRI), and seizure semiology are discordant or no structural lesion is evident on MRI, single-photon emission computed tomography (SPECT) and positron emission tomography (PET) are important examinations for lateralization or localization of epileptic regions. We hypothesized that the concordance between interictal 2-[18F]fluoro-2-deoxy-D-glucose (18FDG)-PET and iomazenil (IMZ)-SPECT could suggest the epileptogenic lobe in patients with non-lesional findings on MRI. METHOD Fifty-nine patients (31 females, 28 males; mean age, 29 years; median age, 27 years; range, 7-56 years) underwent subdural electrode implantation followed by focus resection. All patients underwent 18FDG-PET, IMZ-SPECT, and focus resection surgery. Follow-up was continued for ≥ 2 years. We evaluated surgical outcomes as seizure-free or not and analyzed correlations between outcomes and concordances of low-uptake lobes on PET, SPECT, or both PET and SPECT to the resection lobes. We used uni- and multivariate logistic regression analyses. RESULTS In univariate analyses, all three concordances correlated significantly with seizure-free outcomes (PET, p = 0.017; SPECT, p = 0.030; both PET and SPECT, p = 0.006). In multivariate analysis, concordance between resection and low-uptake lobes in both PET and SPECT correlated significantly with seizure-free outcomes (p = 0.004). The odds ratio was 6.0. CONCLUSION Concordance between interictal 18FDG-PET and IMZ-SPECT suggested that the epileptogenic lobe is six times better than each examination alone among patients with non-lesional findings on MRI. IMZ-SPECT and 18FDG-PET are complementary examinations in the assessment of localization-related epilepsy.
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Usui K, Terada K, Usui N, Matsuda K, Kondo A, Tottori T, Shinozaki J, Nagamine T, Inoue Y. Working memory deficit in drug-resistant epilepsy with an amygdala lesion. EPILEPSY & BEHAVIOR CASE REPORTS 2018; 10:86-91. [PMID: 30094180 PMCID: PMC6071582 DOI: 10.1016/j.ebcr.2018.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/22/2018] [Accepted: 07/06/2018] [Indexed: 11/25/2022]
Abstract
This study compared temporal lobe epilepsy (TLE) patients with amygdala lesion (AL) without hippocampal sclerosis (HS) (TLE-AL) with patients with TLE and HS without AL (TLE-HS). Both subtypes of TLE arose from the right hemisphere. The TLE-AL group exhibited a lower Working Memory Index (WMI) on the Wechsler Adult Intelligence Scale, third edition (WAIS-III), indicating that the amygdala in the right hemisphere is involved in memory-related function. [18F]fluorodeoxyglucose positron emission topography (FDG-PET) showed glucose hypometabolism limited to the right uncus for the TLE-AL group. The results suggest the importance of considering cognitive functions in the non-dominant hemisphere to prevent impairment after surgery. Low working memory index (WMI) was found due to a right amygdala lesion (AL). Glucose hypometabolism was limited to the right uncus for the Temporal Lobe Epilepsy-AL (TLE-AL) patients Glucose hypometabolism was associated with low WMI in the TLE-AL patients We suggest the need to consider cognitive function in non-dominant hemisphere
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Affiliation(s)
- Keiko Usui
- Department of Systems Neuroscience, School of Medicine, Sapporo Medical University, Japan
| | - Kiyohito Terada
- National Hospital Organization, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Japan
| | - Naotaka Usui
- National Hospital Organization, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Japan
| | - Kazumi Matsuda
- National Hospital Organization, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Japan
| | - Akihiko Kondo
- National Hospital Organization, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Japan
| | - Takayasu Tottori
- National Hospital Organization, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Japan
| | - Jun Shinozaki
- Department of Systems Neuroscience, School of Medicine, Sapporo Medical University, Japan
| | - Takashi Nagamine
- Department of Systems Neuroscience, School of Medicine, Sapporo Medical University, Japan
| | - Yushi Inoue
- National Hospital Organization, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Japan
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Kuki I, Matsuda K, Kubota Y, Fukuyama T, Takahashi Y, Inoue Y, Shintaku H. Functional neuroimaging in Rasmussen syndrome. Epilepsy Res 2018; 140:120-127. [PMID: 29331846 DOI: 10.1016/j.eplepsyres.2018.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/14/2017] [Accepted: 01/01/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE For a diagnosis of Rasmussen syndrome (RS), clinical course together with electroencephalography (EEG) and magnetic resonance imaging (MRI) findings are considered important, but there are few reports on functional neuroimaging. This study investigated cerebral blood flow (CBF)-single photon emission computed tomography (SPECT), central benzodiazepine receptor (BZR)-SPECT, and fluorine-18 fluorodeoxy glucose-positron emission tomography (FDG-PET) in RS patients, and correlated neuroimaging results with MRI and pathological findings. METHODS Twenty-three patients diagnosed with RS according to Bien's (2005) diagnostic criteria (including 12 patients with a histological diagnosis) were studied. CBF-SPECT, BZR-SPECT and FDG-PET images were visually evaluated, and the findings correlated with MRI and histological findings. RESULTS Hypoperfusion areas were observed in 16 of 22 patients by interictal CBF-SPECT. Hyperperfusion areas were observed in 10 of 12 patients by ictal CBF-SPECT, which correlated with ictal onset area by ictal EEG (IOAE). In the limited data of BZR-SPECT in nine patients, lowered uptake was detected in all nine patients, including two with no MRI abnormalities. Lowered glucose metabolism was observed in affected areas in all five patients by FDG-PET. Histological examination revealed findings of chronic encephalitis in all 12 patients examined, concomitant with focal cortical dysplasia in five patients. CONCLUSION In RS patients, functional neuroimaging reveals clear abnormal findings, even before the appearance of MRI abnormalities. BZR-SPECT and FDG-PET could detect the IOAE efficiently even in the absence of MRI abnormalities, while interictal CBF-SPECT occasionally failed to detect IOAE if MRI was normal. Based on BZR-SPECT, refractory epileptic seizures in RS may suggest possible impairment of inhibitory neurons.
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Affiliation(s)
- Ichiro Kuki
- Department of Pediatrics, Osaka City University Graduate School of Medicine; National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders.
| | - Kazumi Matsuda
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders
| | | | - Tetsuhiro Fukuyama
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders
| | - Yukitoshi Takahashi
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders
| | - Yushi Inoue
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders
| | - Haruo Shintaku
- Department of Pediatrics, Osaka City University Graduate School of Medicine
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Simultaneous Tc-99m and I-123 dual-radionuclide imaging with a solid-state detector-based brain-SPECT system and energy-based scatter correction. EJNMMI Phys 2016; 3:10. [PMID: 27357946 PMCID: PMC4927533 DOI: 10.1186/s40658-016-0147-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 06/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A brain single-photon emission computed tomography (SPECT) system using cadmium telluride (CdTe) solid-state detectors was previously developed. This CdTe-SPECT system is suitable for simultaneous dual-radionuclide imaging due to its fine energy resolution (6.6 %). However, the problems of down-scatter and low-energy tail due to the spectral characteristics of a pixelated solid-state detector should be addressed. The objective of this work was to develop a system for simultaneous Tc-99m and I-123 brain studies and evaluate its accuracy. METHODS A scatter correction method using five energy windows (FiveEWs) was developed. The windows are Tc-lower, Tc-main, shared sub-window of Tc-upper and I-lower, I-main, and I-upper. This FiveEW method uses pre-measured responses for primary gamma rays from each radionuclide to compensate for the overestimation of scatter by the triple-energy window method that is used. Two phantom experiments and a healthy volunteer experiment were conducted using the CdTe-SPECT system. A cylindrical phantom and a six-compartment phantom with five different mixtures of Tc-99m and I-123 and a cold one were scanned. The quantitative accuracy was evaluated using 18 regions of interest for each phantom. In the volunteer study, five healthy volunteers were injected with Tc-99m human serum albumin diethylene triamine pentaacetic acid (HSA-D) and scanned (single acquisition). They were then injected with I-123 N-isopropyl-4-iodoamphetamine hydrochloride (IMP) and scanned again (dual acquisition). The counts of the Tc-99m images for the single and dual acquisitions were compared. RESULTS In the cylindrical phantom experiments, the percentage difference (PD) between the single and dual acquisitions was 5.7 ± 4.0 % (mean ± standard deviation). In the six-compartment phantom experiment, the PDs between measured and injected activity for Tc-99m and I-123 were 14.4 ± 11.0 and 2.3 ± 1.8 %, respectively. In the volunteer study, the PD between the single and dual acquisitions was 4.5 ± 3.4 %. CONCLUSIONS This CdTe-SPECT system using the FiveEW method can provide accurate simultaneous dual-radionuclide imaging. A solid-state detector SPECT system using the FiveEW method will permit quantitative simultaneous Tc-99m and I-123 study to become clinically applicable.
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Doucet GE, He X, Sperling M, Sharan A, Tracy JI. Frontal gray matter abnormalities predict seizure outcome in refractory temporal lobe epilepsy patients. NEUROIMAGE-CLINICAL 2015; 9:458-66. [PMID: 26594628 PMCID: PMC4596924 DOI: 10.1016/j.nicl.2015.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/04/2015] [Accepted: 09/08/2015] [Indexed: 12/20/2022]
Abstract
Developing more reliable predictors of seizure outcome following temporal lobe surgery for intractable epilepsy is an important clinical goal. In this context, we investigated patients with refractory temporal lobe epilepsy (TLE) before and after temporal resection. In detail, we explored gray matter (GM) volume change in relation with seizure outcome, using a voxel-based morphometry (VBM) approach. To do so, this study was divided into two parts. The first one involved group analysis of differences in regional GM volume between the groups (good outcome (GO), e.g., no seizures after surgery; poor outcome (PO), e.g., persistent postoperative seizures; and controls, N = 24 in each group), pre- and post-surgery. The second part of the study focused on pre-surgical data only (N = 61), determining whether the degree of GM abnormalities can predict surgical outcomes. For this second step, GM abnormalities were identified, within each lobe, in each patient when compared with an ad hoc sample of age-matched controls. For the first analysis, the results showed larger GM atrophy, mostly in the frontal lobe, in PO patients, relative to both GO patients and controls, pre-surgery. When comparing pre-to-post changes, we found relative GM gains in the GO but not in the PO patients, mostly in the non-resected hemisphere. For the second analysis, only the frontal lobe displayed reliable prediction of seizure outcome. 81% of the patients showing pre-surgical increased GM volume in the frontal lobe became seizure free, post-surgery; while 77% of the patients with pre-surgical reduced frontal GM volume had refractory seizures, post-surgery. A regression analysis revealed that the proportion of voxels with reduced frontal GM volume was a significant predictor of seizure outcome (p = 0.014). Importantly, having less than 1% of the frontal voxels with GM atrophy increased the likelihood of being seizure-free, post-surgery, by seven times. Overall, our results suggest that using pre-surgical GM abnormalities within the frontal lobe is a reliable predictor of seizure outcome post-surgery in TLE. We believe that this frontal GM atrophy captures seizure burden outside the pre-existing ictal temporal lobe, reflecting either the development of epileptogenesis or the loss of a protective, adaptive force helping to control or limit seizures. This study provides evidence of the potential of VBM-based approaches to predict surgical outcomes in refractory TLE candidates. Gray matter abnormalities within the frontal lobe predicts seizure outcome in TLE. Poor outcome patients suffer from GM atrophy in the frontal lobe, pre-surgery. Good outcome patients show gain of GM in the non-resected hemisphere, post-surgery. Frontal GM atrophy captures seizure burden outside the ictal temporal lobe.
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Affiliation(s)
- Gaelle E Doucet
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Xiaosong He
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Michael Sperling
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ashwini Sharan
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Joseph I Tracy
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Cognitive dysfunction might be improved in association with recovered neuronal viability after intracranial meningioma resection. Brain Res 2014; 1574:50-9. [DOI: 10.1016/j.brainres.2014.05.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 02/27/2014] [Accepted: 05/30/2014] [Indexed: 11/20/2022]
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Saito H, Magota K, Zhao S, Kubo N, Kuge Y, Shichinohe H, Houkin K, Tamaki N, Kuroda S. 123
I-Iomazenil Single Photon Emission Computed Tomography Visualizes Recovery of Neuronal Integrity by Bone Marrow Stromal Cell Therapy in Rat Infarct Brain. Stroke 2013; 44:2869-74. [DOI: 10.1161/strokeaha.113.001612] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background and Purpose—
This study was aimed to assess whether
123
I-iomazenil (IMZ) single photon emission computed tomography can serially monitor the effects of bone marrow stromal cell (BMSC) transplantation on neuronal integrity in infarct brain of rats.
Methods—
The BMSCs were harvested from green fluorescent protein–transgenic rats and were cultured. The rats were subjected to permanent middle cerebral artery occlusion. Their motor function was serially quantified throughout the experiments. The BMSCs or vehicle was stereotactically transplanted into the ipsilateral striatum at 7 days after the insult. Using small-animal single photon emission computed tomography/computed tomography apparatus, the
123
I-IMZ uptake was serially measured at 6 and 35 days after the insult. Finally, fluorescence immunohistochemistry was performed to evaluate the distribution of engrafted cells and their phenotypes.
Results—
The distribution of
123
I-IMZ was markedly decreased in the ipsilateral neocortex at 6 days postischemia. The vehicle-transplanted animals did not show a significant change at 35 days postischemia. However, BMSC transplantation significantly improved the distribution of
123
I-IMZ in the peri-infarct neocortex as well as motor function. The engrafted BMSCs were densely distributed around cerebral infarct, and some of them expressed neuronal nuclear antigen and γ-aminobutyric acid type-A receptor.
Conclusions—
The present findings strongly suggest that the BMSCs may enhance functional recovery by improving the neuronal integrity in the peri-infarct area, when directly transplanted into the infarct brain at clinically relevant timing.
123
I-IMZ single photon emission computed tomography may be a promising modality to scientifically prove the beneficial effects of BMSC transplantation on the host brain in clinical situation.
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Affiliation(s)
- Hisayasu Saito
- From the Departments of Neurosurgery (H. Saito, H. Shichinohe, K.H., S.K.), Nuclear Medicine (K.M., N.T.), and Tracer Kinetics and Bioanalysis (S.Z.), Hokkaido University Graduate School of Medicine, Sapporo, Japan; Central Institute of Isotope Science, Hokkaido University, Sapporo, Japan (N.K., Y.K.); and Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan (S.K.)
| | - Keiichi Magota
- From the Departments of Neurosurgery (H. Saito, H. Shichinohe, K.H., S.K.), Nuclear Medicine (K.M., N.T.), and Tracer Kinetics and Bioanalysis (S.Z.), Hokkaido University Graduate School of Medicine, Sapporo, Japan; Central Institute of Isotope Science, Hokkaido University, Sapporo, Japan (N.K., Y.K.); and Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan (S.K.)
| | - Songji Zhao
- From the Departments of Neurosurgery (H. Saito, H. Shichinohe, K.H., S.K.), Nuclear Medicine (K.M., N.T.), and Tracer Kinetics and Bioanalysis (S.Z.), Hokkaido University Graduate School of Medicine, Sapporo, Japan; Central Institute of Isotope Science, Hokkaido University, Sapporo, Japan (N.K., Y.K.); and Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan (S.K.)
| | - Naoki Kubo
- From the Departments of Neurosurgery (H. Saito, H. Shichinohe, K.H., S.K.), Nuclear Medicine (K.M., N.T.), and Tracer Kinetics and Bioanalysis (S.Z.), Hokkaido University Graduate School of Medicine, Sapporo, Japan; Central Institute of Isotope Science, Hokkaido University, Sapporo, Japan (N.K., Y.K.); and Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan (S.K.)
| | - Yuji Kuge
- From the Departments of Neurosurgery (H. Saito, H. Shichinohe, K.H., S.K.), Nuclear Medicine (K.M., N.T.), and Tracer Kinetics and Bioanalysis (S.Z.), Hokkaido University Graduate School of Medicine, Sapporo, Japan; Central Institute of Isotope Science, Hokkaido University, Sapporo, Japan (N.K., Y.K.); and Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan (S.K.)
| | - Hideo Shichinohe
- From the Departments of Neurosurgery (H. Saito, H. Shichinohe, K.H., S.K.), Nuclear Medicine (K.M., N.T.), and Tracer Kinetics and Bioanalysis (S.Z.), Hokkaido University Graduate School of Medicine, Sapporo, Japan; Central Institute of Isotope Science, Hokkaido University, Sapporo, Japan (N.K., Y.K.); and Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan (S.K.)
| | - Kiyohiro Houkin
- From the Departments of Neurosurgery (H. Saito, H. Shichinohe, K.H., S.K.), Nuclear Medicine (K.M., N.T.), and Tracer Kinetics and Bioanalysis (S.Z.), Hokkaido University Graduate School of Medicine, Sapporo, Japan; Central Institute of Isotope Science, Hokkaido University, Sapporo, Japan (N.K., Y.K.); and Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan (S.K.)
| | - Nagara Tamaki
- From the Departments of Neurosurgery (H. Saito, H. Shichinohe, K.H., S.K.), Nuclear Medicine (K.M., N.T.), and Tracer Kinetics and Bioanalysis (S.Z.), Hokkaido University Graduate School of Medicine, Sapporo, Japan; Central Institute of Isotope Science, Hokkaido University, Sapporo, Japan (N.K., Y.K.); and Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan (S.K.)
| | - Satoshi Kuroda
- From the Departments of Neurosurgery (H. Saito, H. Shichinohe, K.H., S.K.), Nuclear Medicine (K.M., N.T.), and Tracer Kinetics and Bioanalysis (S.Z.), Hokkaido University Graduate School of Medicine, Sapporo, Japan; Central Institute of Isotope Science, Hokkaido University, Sapporo, Japan (N.K., Y.K.); and Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan (S.K.)
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Fujitani S, Matsuda K, Nakamura F, Baba K, Usui N, Tottori T, Mihara T, Terada K, Usui K, Inoue Y, Kajita Y, Wakabayashi T. Statistical parametric mapping of interictal 123I-iomazenil SPECT in temporal lobe epilepsy surgery. Epilepsy Res 2013; 106:173-80. [PMID: 23582957 DOI: 10.1016/j.eplepsyres.2013.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 02/04/2013] [Accepted: 03/20/2013] [Indexed: 10/27/2022]
Abstract
Brain single photon emission computed tomography (SPECT) for epilepsy is divided into two types (using three radionuclide tracers)-perfusion SPECT (123I-IMP or 99 mTc-ECD), identifying epileptogenic foci by detecting abnormality in regional cerebral blood flow, and 123I-iomazenil SPECT, identifying epileptogenic foci based on distribution of central benzodiazepine receptors. This study aimed to statistically evaluate and compare the SPECT effectiveness for the three tracers. Statistical parametric mapping (SPM) analysis was performed on 30 mesial temporal lobe epilepsy (mTLE) patients. The radionuclide and patient data were categorized as follows: abnormality in the medial temporal lobe on the operated hemisphere (AAA), in the entire temporal lobe on the operated hemisphere (AA), in the dominantly affected temporal lobe on the operated hemisphere (A), in bilateral temporal lobes (B), with no abnormalities in bilateral temporal lobes (C), and with abnormality in the temporal lobe on the nonoperated hemisphere (D). For analyses of (AAA), (AA), and (A), examining the hemisphere containing epileptogenic foci, IMP-SPECT was significantly superior to ECD-SPECT (P<0.05). For (AAA), indicating localization, IMZ-SPECT was significantly superior to the other two (P<0.05). IMP-SPECT was superior for lateralizing and IMZ-SPECT was useful for localizing epileptogenic foci in mTLE patients though the applicability of the results in extratemporal lobe epilepsy is unknown.
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Affiliation(s)
- Shigeru Fujitani
- Japanese Red Cross Nagoya First Hospital, Michishita-cho 3-35, Nakamura-ku, Nagoya City, Aichi, Japan.
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Hosomi K, Kishima H, Oshino S, Hirata M, Tani N, Maruo T, Khoo HM, Shimosegawa E, Hatazawa J, Kato A, Yoshimine T. Altered extrafocal iomazenil activity in mesial temporal lobe epilepsy. Epilepsy Res 2013; 103:195-204. [DOI: 10.1016/j.eplepsyres.2012.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 06/06/2012] [Accepted: 07/03/2012] [Indexed: 11/28/2022]
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Recovered neuronal viability revealed by Iodine-123-iomazenil SPECT following traumatic brain injury. J Cereb Blood Flow Metab 2010; 30:1673-81. [PMID: 20683454 PMCID: PMC3023407 DOI: 10.1038/jcbfm.2010.75] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We evaluated cortical damages following traumatic brain injury (TBI) in the acute phase with [(123)I] iomazenil (IMZ) single photon emission computed tomography (SPECT). In all, 12 patients with cerebral contusion following TBI were recruited. All patients underwent IMZ SPECT within 1 week after TBI. To investigate the changes in distribution of IMZ in the cortex in the chronic phase, after conventional treatment, patients underwent IMZ SPECT again. A decrease in the accumulation of radioligand for the central benzodiazepine receptor in the cortex corresponding to the contusion revealed with computed tomography (CT) scans and magnetic resonance imaging (MRI) were shown on IMZ SPECT in the acute phase in all patients. In 9 of 12 patients (75%), images of IMZ SPECT obtained in the chronic phase of TBI showed that areas with a decreased distribution of IMZ were remarkably reduced in comparison with those obtained in the acute phase. Both CT scans and MRI showed a normal appearance of the cortex morphologically, where the binding potential of IMZ recovered in the chronic phase. Reduced binding potential of radioligand for the central benzodiazepine receptor is considered to be an irreversible reaction; however, in this study, IMZ accumulation in the cortex following TBI was recovered in the chronic phase in several patients. [(123)I] iomazenil SPECT may have a potential to disclose a reversible vulnerability of neurons following TBI.
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Epileptic negative myoclonus: A combined study of EEG and [123I]iomazenil (123I-IMZ) single photon emission computed tomography indicating involvement of medial frontal area. Epilepsy Res 2010; 89:220-6. [PMID: 20133106 DOI: 10.1016/j.eplepsyres.2010.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 10/20/2009] [Accepted: 01/10/2010] [Indexed: 11/21/2022]
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Umeoka S, Baba K, Mihara T. SYMPTOMATIC LAUGHTER IN A PATIENT WITH ORBITOFRONTAL SEIZURE: A SURGICAL CASE WITH INTRACRANIAL ELECTROENCEPHALOGRAPHIC STUDY. Neurosurgery 2008; 63:E1205-6; discussion E1206. [DOI: 10.1227/01.neu.0000335169.86155.65] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
OBJECTIVE
A rare case of orbitofrontal lobe epilepsy manifesting gelastic seizure is reported.
CLINICAL PRESENTATION
A 49-year-old woman had developed weekly complex partial seizures consisting of nonverbal vocalization and unresponsiveness followed by laughter. Magnetic resonance imaging revealed a round tumorous lesion at the posterior side of the right rectal gyrus and medial orbitofrontal gyrus. Neuroimaging studies and electrophysiological examinations, including intracranial electroencephalographic monitoring, suggested the existence of an epileptogenic zone in the ipsilateral orbitofrontal gyrus, including the lesion.
INTERVENTION
After partial right prefrontal lobectomy including lesionectomy, the patient became seizure-free during a follow-up period of 33 months. We speculated that the limbic system, including the orbitofrontal lobe and temporal structures, which have a strong connection with the pontine nuclei, might be involved in this patient's gelastic seizure.
CONCLUSION
Except for impaired consciousness, the clinical manifestations did not correspond to the characteristics of orbitofrontal seizure described by the International League Against Epilepsy. Symptomatic laughter in epilepsy that originates from the orbitofrontal lobe is very rare. Intracranial electroencephalographic findings and ictal symptomatology associated with epileptogenesis in this rare case are discussed.
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Affiliation(s)
- Shuichi Umeoka
- Department of Neurological Surgery, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Koichi Baba
- Department of Neurological Surgery, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Tadahiro Mihara
- Department of Neurological Surgery, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
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