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Evaluating the Development of a SPECT Protocol in a Canadian Epilepsy Unit

Published online by Cambridge University Press:  02 December 2014

J. G. Burneo ,
W. Vezina ,
J. Romsa ,
B. J. Smith  and
R. S. McLachlan
J. G. Burneo
Affiliation:
Epilepsy Programme, University of Western Ontario, London, ON, Canada
W. Vezina
Affiliation:
Department of Nuclear Medicine, University of Western Ontario, London, ON, Canada
J. Romsa
Affiliation:
Department of Nuclear Medicine, University of Western Ontario, London, ON, Canada
B. J. Smith
Affiliation:
Comprehensive Epilepsy Program, Henry Ford Health Systems, Detroit, MI, USA
R. S. McLachlan
Affiliation:
Epilepsy Programme, University of Western Ontario, London, ON, Canada
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Abstract

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Background:

Functional neuroimaging can address some challenges of seizure localization, and sometimes preclude the need for EEG recording using intracranial electrodes. Ictal Single Photon Emission Computed Tomography (SPECT) has developed into an important tool in the presurgical evaluation of patients with medically-intractable localization-related epilepsy. The purpose of the study was to determine whether the development of a programme using trained nurses to perform ictal injections enabled a more efficient delivery of radiopharmaceuticals and therefore a greater sensitivity and specificity of outcome.

Methods:

In our epilepsy unit, nursing staff inject 99mTc-HMPAO at bedside, during or at seizure onset. Brain SPECT is performed later on a gamma camera.

Results:

Since the implementation of the new protocol (February 2005), 57 scans have been performed: 22 ictal and 35 interictal. Latency of ictal injection was found to be 5-40 seconds (mean 19.7 sec, standard deviation (SD) 10.4). Only 20% of reconstituted radiopharmaceutical vials were not used. Contamination rate was nil. Sixty three percent of SPECT studies were concordant with standard presurgical evaluation.

Conclusion:

The latency of injections and the percentage of unused vials indicated an efficient and effective protocol compared to the literature. Our results show that ictal SPECT can be a safe, noninvasive procedure performed on a routine basis in the epilepsy unit when appropriately trained support staff are incorporated into a structured multidisciplinary programme.

Résumé:

RÉSUMÉ:Contexte:

La neuroimagerie fonctionnelle peut permettre de relever certains défis que pose la localisation des crises convulsives et obvier à la nécessité de recourir à l'enregistrement ÉEG effectué au moyen d'électrodes intracrâniennes. La TEMP ictale est devenue un outil important dans l'évaluation préchirurgicale de patients ayant une épilepsie localisée, réfractaire au traitement médical. Le but de cette étude était de déterminer si le développement d'un programme d'injection ictale par des infirmières ayant reçu une formation pertinente permettrait d'optimiser l'administration des substances radiopharmaceutiques et donc d'améliorer la sensibilité et la spécificité des résultats.

Méthodes :

Le personnel infirmier de notre unité d'épilepsie injecte le 99mTc-HMPAO au chevet du malade pendant ou au début de la crise convulsive. La TEMP du cerveau est ensuite réalisée par une caméra à rayons gamma.

Résultats :

Depuis l'implantation du nouveau protocole en février 2005, cinquante-sept scintigraphies ont été effectuées, soit 22 scintigraphies ictales et 35 interictales. La latence de l'injection ictale était de 5 à 40 secondes (moyenne 19,7 secondes, écart type 10,4 secondes). Seulement 20% des flacons de substance radiopharmaceutique reconstituée n'ont pas été utilisés. Le taux de contamination a été nul. Les résultats de soixante-trois pour cent des études TEMP concordaient avec ceux de l'évaluation préchirurgicale standard.

Conclusion :

Le temps de latence des injections et le pourcentage de flacons inutilisés indiquent qu'il s'agit d'un protocole efficace, ayant un bon rendement, comparé à ce qui est rapporté dans la littérature. Nos résultats démontrent que la TEMP ictale peut être une intervention sûnon effractive, pratiquée de routine dans l'unité d'épilepsie quand un personnel de soutien formé est incorporé à un programme multidisciplinaire structuré.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 34 , Issue 2 , May 2007 , pp. 225 - 229
Copyright
Copyright © The Canadian Journal of Neurological 2007

References

1. Burneo, JG, Tellez-Zenteno, J, Wiebe, S. Understanding the burden of epilepsy in Latin America: a systematic review of its prevalence and incidence. Epilep Res. 2005; 66(1-3):63-74.CrossRefGoogle ScholarPubMed
2. Hauser, WA, Hesdorffer, DC. Epidemiology of intractable epilepsy. In: Luders, HO, Comair, YG, editors. Epilepsy Surgery. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2001; p. 55-61.Google Scholar
3. Begley, CE, Annegers, JF, Lairson, DR, Reynolds, TF, Hauser, WA. Cost of epilepsy in the United States: a model based on incidence and prognosis. Epilepsia. 1994; 35(6):1230-43.CrossRefGoogle Scholar
4. Wiebe, S. Early epilepsy surgery. Curr Neurol Neurosci Rep. 2004; 4(4):315-20.Google Scholar
5. Knowlton, RC, Lawn, ND, Mountz, JM, Kuzniecky, RI. Ictal SPECT analysis in epilepsy: subtraction and statistical parametric mapping techniques. Neurology. 2004; 63(1):10-5.Google Scholar
6. Kuzniecky, R, Mountz, JM, Thomas, F. Ictal 99mTc HM-PAO brain single-photon emission computed tomography in electro-encephalographic nonlocalizable partial seizures. J Neuroimaging. 1993; 3(2): 100-2.Google Scholar
7. Newton, MR, Berkovic, SF, Austin, MC, Rowe, CC, McKay, WJ, Bladin, PF. Postictal switch in blood flow distribution and temporal lobe seizures. J Neurol Neurosurg Psychiatry. 1992; 55(10):891-4.Google Scholar
8. Rowe, CC, Berkovic, SF, Austin, MC, McKay, WJ, Bladin, PF. Patterns of postictal cerebral blood flow in temporal lobe epilepsy: qualitative and quantitative analysis. Neurology. 1991; 41(7):1096-103.Google Scholar
9. Vanbilloen, H, Dupont, P, Mesotten, L, et al. Simple design for rapid self-injection ictal SPET during aura. Eur J Nucl Med. 1999; 26(10):1380-1.Google ScholarPubMed
10. Smith, BJ, Karvelis, KC, Cronan, S, Porter, W, Smith, L, Pantelic, MV, et al. Developing an effective program to complete ictal SPECT in the epilepsy monitoring unit. Epilepsy Res. 1999; 33(2-3):189-97.Google Scholar
11. Newton, MR, Berkovic, SF, Austin, MC, Rowe, CC, McKay, WJ, Bladin, PF. Ictal postictal and interictal single-photon emission tomography in the lateralization of temporal lobe epilepsy. Eur J Nucl Med. 1994; 21(10):1067-71.Google Scholar
12. Rowe, CC, Berkovic, SF, Sia, ST, Austin, M, McKay, WJ, Kalnins, RM, et al. Localization of epileptic foci with postictal single photon emission computed tomography. Ann Neurol. 1989; 26(5):660-8.CrossRefGoogle ScholarPubMed