Contribution of SISCOM in the investigation of temporal pole blurring in patients with temporal lobe rpilepsy and hippocampal atrophy: a brain SPECT study

This was a retrospective study of 18 patients with hippocampal atrophy (HA) and 21 patients with HA associated to temporopolar blurring (TPB). We performed an investigation of perfusion changes of ictal single photon emission computed tomography (SPECT), interictal SPECT and subtraction ictal SPECT coregistered to magnetic resonance imaging (SISCOM) and its comparison with results of presurgical evaluation. Patients with TPB showed earlier epilepsy onset, longer duration of epilepsy and a longer period of post surgical follow-up. The ipsilateral perfusion pattern in the ictal SPECT, which we denominated -typical? pattern, was the most frequent in both groups of patients, with and wihout TPB. In the interictal SPECT, most of patients with TPB showed ipsilateral hypoperfusion to the epileptogenic temporal pole (TP), while in the group without TPB this hypoperfusion was observed in half of the patients. Through SISCOM, the typical perfusion pattern was the most frequent in both groups. However, the patterns considered -atypical? were found more frequently in patients with TPB, which suggests a pattern of propagation of epileptic seizures slightly different in the group with TPB, which involves other areas of TL bilaterally. Adversely to our hypothesis, we did not found association between the occurrence of TPB and the hyperperfusion in the TP neither in the ictal SPECT nor SISCOM. Based on this finding, our data does not support the idea that the BTP is a result of interictal secondary tissue changes due to a higher involvement or role of this pole in the generation or propagation of epileptic seizures in the mesial temporal lobe epilepsy (TLE). On the other hand, our results suggest that the TP is a region frequently involved by seizures of TL. Particularly, the hyperperfusion in the TP which is ipsilateral to the HA through SISCOM was the most found in patients with typical clinical cases of mesial TLE, suggesting that the TP is frequently involved (a typical pattern) in epileptic seizures of clinical cases with more concordant information (clearcut) and suggestive of unilateral mesial TLE (AU)