TECHNETIUM-99M-HMPAO SPECT IN PARTIAL STATUS EPILEPTICUS

In this paper we correlate the findings on Tc-99m-HMPAO brain SPECT wi th the results of clinical examinations and electroencephalography to determine the utility of SPECT in the evaluation of patients with susp ected status epilepticus. Methods: Thirteen patients with suspected st atus epilepticus underwent serial neurologic examinations, serial elec troencephalograms, CT/MRI scanning and (TC)-T-99m-HMPAO SPECT. Seven p atients were diagnosed with status epilepticus and six patients receiv ed other neurological diagnoses. Results: All patients with status epi lepticus at the time of the brain SPECT scan demonstrated focal hyperp erfusion on SPECT in an area concordant with that suggested by EEG. On e patient with status epilepticus demonstrated a persistent area of hy perperfusion on SPECT 24 hr after the cessation of status with no evid ence of breakdown in the blood-brain barrier demonstrated by Tc-99m-DT PA SPECT. No patient in this study without a diagnosis of status epile pticus had focal areas of hyperperfusion on SPECT. Conclusion: We sugg est that a Tc-99m-HMPAO SPECT scan demonstrating focal hyperperfusion in a patient being evaluated for partial status epilepticus is nonspec ific. Even in the absence of a structural lesion causing local breakdo wn in the blood-brain barrier, it may indicate either ongoing status e pilepticus or recently terminated status. However, a SPECT scan demons trating no area of focal hyperperfusion argues against the diagnosis o f partial status.