Partial Epileptic Seizure with Versive Movements Examined by [99mTc] HM-PAO Brain Single Photon Emission Computed Tomography: An Early Postictal Case Study Analyzed by Computerized Brain Atlas Methods

Summary: The consecutive steps of a seizure with leftward versive movements of the head and eyes were analyzed after video monitoring and correlated with findings on single photon emission computed tomography (SPECT) using [99mTc] hexamethyl propylene amine oxime (HM-PAO). Evaluation included reconstruction of subtraction images from the early postictal state, obtained immediately after the video-monitored seizure, and the interictal baseline. Based on normalized perfusion indexes within voxels of Talairach space, we concluded that the primary epileptogenic focus was in the premotor cortex of the contralateral hemisphere. We then placed the functional data in an anatomic context by adapting a dedicated computerized brain atlas (CBA) to the patient's brain with the aid of magnetic resonance imaging (MRI) slices. By inverse transformation, the patient's data were aligned with the standard geometry of the brain atlas for comparison purposes with data from the literature. The validated activation field projected exactly onto the right precentral sulcus with the anterior border zone including the right frontal eye field.