| "Subtracted SPECT를 이용한 측두엽 간질의
dystonic posturing에 관한 연구" |
| 주은연 , 이은경 태우석 한도훈 정기영 서대원 홍승철 홍승봉 |
| 성균관대학교 의과대학 삼성서울병원 신경과학교실, 신경외과학교실,신경영상연구실 |
| "Ictal Hyperperfusion of Brain Structures Related to Ictal Dystonic
Posturing in Temporal Lobe Seizures" |
| Eun Yeon Joo |
| "Departments of Neurology* and Neurosurgery†, Neuroimaging Laboratory‡ of Neurology,
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea." |
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| Abstract |
"Background: Although dystonic posturing (DP) during temporal lobe seizures is known to be related to basal ganglia
activation, the mechanism of the dystonic posturing has not been investigated in greater details .
Methods: Thirty-two
patients with mesial temporal lobe epilepsy (TLE) underwent ictal and interictal SPECTs. They were classified into two
groups: 1) DP with ictal dystonia during ictal SPECT (N=15) and 2) Non-DP without dystonia (N=17). Ictal-interictal
SPECT subtraction was performed as follows: co-registration, intensity normalization, subtraction, thresholding and
then an overlay to SPGR MRI. The presence and intensity of ictal hyperperfusion were determined in frontal lobe, basal
ganglia, temporal lobe and insular cortex.
Results: The incidences of ictal hyperperfusion in DP vs. Non-DP were caudate
nucleus [80.0%(12/15 patients) vs. 0% (0/17), p=0.001], putamen [93.3% (14/15) vs. 48.2% (8/17), p=0.005],
globus pallidus [53.3% (8/15) vs. 23.5% (4/17), p=0.082], thalamus [80.0% (12/15) vs. 41.2% (7/17), p=0.026], insular
cortex [46.7% (7/15) vs.23.5% (4/17), p=0.051], orbitofrontal [46.7% (6/15) vs. 35.3% (7/17), p=0.053], medial frontal
[6.7% (1/15) vs. 18.7% (2/17), p=0.621], dorsolateral frontal [13.3% (2/15) vs. 18.7%(2/17), p=0.737] in the hemisphere
of epileptic side. In patients who showed ictal hyperperfusion in striatum and thalamus, the average intensity of
hyperperfusion in DP vs. Non-DP was caudate nucleus 1.67 vs. 0.0, putamen 2.20 vs. 1.05, globus pallidus 1.2 vs. 0.65,
thalamus 2.00 vs. 0.88 in the epileptic hemisphere.
Conclusions: Caudate nucleus as well as putamen appeared to be
important for producing ictal dystonia during TLE seizures. The greater intensity of ictal hyperperfusion in putamen,
caudate nucleus and thalamus seems to be related to ictal dystonia.Key Words: Ictal dystonia, SPECT subtraction, Ictal hyperperfusion, Basal ganglia" |
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