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Departments of Nuclear Medicine and Epileptology, University of Bonn
Du Pont Pharma, Bonn, Germany
Correspondence: For correspondence and reprints contact: Priv.-Doz. Dr. Frank Grünwald, Department of Nuclear Medicine, University of Bonn, Sigmund Freud Str. 25, 53127 Bonn, Germany.
ABSTRACT
The aim of this study was to evaluate the use of 99mTc-ethyl cysteinate dimer (ECD), also known as 99mTc-bicisate, in the presurgical evaluation of patients suffering from medically intractable epilepsy. Methods: Twenty-three brain SPECT studies (8 ictally and 15 interictally) were performed on 16 patients with a high-resolution annular SPECT system (CERASPECT). For the ictal studies, the tracer was injected in the very early phase of the seizure. The delay between seizure onset and 99mTc-ECD injection was 2–20 sec. Results: Interictally, all patients showed circumscribed hypoperfusions. In four patients, the SPECT lesion represented only structural defects. Circumscribed increased tracer uptake was observed in all ictal studies. For all patients with temporal lobe epilepsy without significant mass lesion, in whom an interictal and ictal 99mTc-ECD-SPECT study could be obtained, the asymmetry index was 0.88 ± 0.03 for the interictal and 1.23 ± 0.08 for the ictal studies. Conclusion: The data suggest that 99mTc-ECD is an effective marker of cerebral perfusion imaging in epilepsy. In comparison to other tracers, it has a high in vitro stability and is therefore particularly useful for ictal studies in the very early phase after seizure onset.
Key Words: technetium-99m-ECD • brain SPECT • epilepsy
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