Developing an effective program to complete ictal SPECT in the epilepsy monitoring unit

With the availability of more stable radiopharmaceuticals, the ictal single photon emission computed tomography (SPECT) perfusion study has emerged as a useful noninvasive functional neuroimaging tool in the presurgical evalu ation of patients with medically intractable partial epilepsy. The purpose of this study was to determine whether the development of a program using t rained electroencephalography (EEG) technologists to perform ictal injectio ns in the epilepsy monitoring unit enabled a more efficient delivery of rad iopharmaceuticals and therefore a higher specificity and sensitivity of out come. All patients admitted to the epilepsy monitoring unit for prolonged v ideo/EEG monitoring as part of the presurgical evaluation were eligible for completion of an ictal SPECT study using a three-way needle-free apparatus . Over a 19-month period, 85 (77%) of 110 eligible patients were successful ly injected during typical partial seizures. Various factors were analyzed including latency of ictal injection (27.3 +/- 20.8 [S.D.] s), radiopharmac eutical wastage (40% dose utilization), radiation safety parameters (1.6% c ontamination rate), and preliminary data of localizing value. Our results s how that ictal SPECT can be a safe, noninvasive procedure completed on a ro utine basis in the epilepsy monitoring unit when appropriately trained supp ort staff are utilized as part of a structured multidisciplinary program. ( C) 1999 Elsevier Science B.V. All rights reserved.