Ni. Bohnen et al., CEREBELLAR CHANGES IN PARTIAL SEIZURES - CLINICAL CORRELATIONS OF QUANTITATIVE SPECT AND MRI ANALYSIS, Epilepsia, 39(6), 1998, pp. 640-650
Purpose: To determine the frequency and patterns of periictal cerebell
ar hyperperfusion, whether it is associated with increased cerebellar
atrophy, and whether cerebellar hyperperfusion and cerebellar atrophy
are associated with predisposing clinical factors or with the outcome
of epilepsy surgery. Methods: Periictal and interictal SPECT scans and
volumetric brain magnetic resonance imaging(MRT) were quantitatively
analyzed in 54 consecutive patients with medically refractory partial
epilepsy. Their histories were reviewed and their postsurgical outcome
s assessed. Results: Significant periictal cerebellar hyperperfusion w
as found in 26 (48.1%) patients, of whom 18 had CCH, two had homolater
al cerebellar hyperperfusion (HCH), and six had symmetrical bilateral
hyperperfusion (BCH). No relation found between the site of the SPECT
seizure localization and the presence or type of cerebellar hyperperfu
sion. CCH was more common when the injected seizure involved unilatera
l clonic motor activity (p < 0.05). A smaller MRI relative cerebellar
volume(cerebellar volume/cerebral volume) was correlated with a greate
r seizure frequency (R-s = -0.30; p < 0.05) but not with the duration
of epilepsy. There was no difference in the cerebellar volumes between
the different patterns of cerebellar perfusion (p > 0.05). However, p
atients without a focal structural MRI lesion had significantly smalle
r cerebellar volumes (p < 0.05). In patients who underwent epilepsy su
rgery (n = 31), there was a trend for those without excellent outcomes
to have smaller relative cerebellar volumes than did those with excel
lent outcome (10.6 vs. 11.8%; p = 0.08). Conclusions: Periictal change
s in cerebellar perfusion, particularly CCH, are common in patients wi
th intractable partial epilepsy. However, periictal hyperperfusion doe
s not appear to be a major contributor to the development of cerebella
r atrophy.