Video-EEG and ictal SPECT in three patients with both epileptic and non-epileptic seizures

We report scalp EEC and ictal SPECT findings in epileptic (complex partial) and non-epileptic seizures in three patients who experienced both types of event during presurgical investigation of medically intractable epilepsies . In all three patients, ictal SPECT showed localizing changes in cerebral blood flow during epileptic seizures, but showed no change during pseudosei zures. In two patients, the physical manifestations of the pseudoseizures w ere similar to those of the epileptic seizures, supporting the contention t hat physiological activation is unlikely to mimic ictal perfusion changes. In one patient, the EEC recording was rendered difficult to interpret by mu scle artefact, while SPECT was clear and showed no change. SPECT is not a p rimary tool for diagnosis of pseudoseizures, bur when patients undergoing p resurgical investigation are injected during pseudoseizures, then SPECT is unlikely to show misleading perfusion changes due to activation effects, an d may aid diagnosis where there is muscle artefact on EEG.