INTRODUCTION: Epilepsy is one of the major neurological disorders, affecting roughly 0.5-2% of the world's population and approximately 20-25% of patients are resistant to medication. AIM: To analyze the response of cerebral perfusion (assessed by SPECT) and bioelectrical activity (measured in scalp and mesial temporal region) to etomidate. PATIENTS AND METHODS: We studied 10 patients presurgically evaluated and studied by video-EEG with foramen ovale electrodes (EFO) and SPECT. Etomidate was administered (0.1 mg/kg), followed by (99)mTc-HmPAO during the study in the video-EEG + EFO. RESULTS: The side-effects consisted of myoclonus (n = 7) and moderate pain (n = 2). There had been no significant respiratory or cardiovascular effects. The bioelectrical activity in the scalp consisted in a brief initial rapid activity, followed by a generalized and hypervoltaged delta pattern for several minutes. In the epileptogenic zone, there was a marked increase of interictal activity. Increased cerebral perfusion was observed in all areas studied, especially in temporal region (mesial and lateral) areas and thalamus. In the tail of the non-epileptic hippocampus, we observed the second largest increase in cerebral perfusion, the only region that is different from contralateral area. CONCLUSIONS: Activation by etomidate induces a specific and repetitive response in the bioelectrical activity. In addition, cerebral perfusion changes directly related to the epileptogenic region may serve therefore as a diagnostic tool in the near future.
INTRODUCTION:Epilepsy is one of the major neurological disorders, affecting roughly 0.5-2% of the world's population and approximately 20-25% of patients are resistant to medication. AIM: To analyze the response of cerebral perfusion (assessed by SPECT) and bioelectrical activity (measured in scalp and mesial temporal region) to etomidate. PATIENTS AND METHODS: We studied 10 patients presurgically evaluated and studied by video-EEG with foramen ovale electrodes (EFO) and SPECT. Etomidate was administered (0.1 mg/kg), followed by (99)mTc-HmPAO during the study in the video-EEG + EFO. RESULTS: The side-effects consisted of myoclonus (n = 7) and moderate pain (n = 2). There had been no significant respiratory or cardiovascular effects. The bioelectrical activity in the scalp consisted in a brief initial rapid activity, followed by a generalized and hypervoltaged delta pattern for several minutes. In the epileptogenic zone, there was a marked increase of interictal activity. Increased cerebral perfusion was observed in all areas studied, especially in temporal region (mesial and lateral) areas and thalamus. In the tail of the non-epileptic hippocampus, we observed the second largest increase in cerebral perfusion, the only region that is different from contralateral area. CONCLUSIONS: Activation by etomidate induces a specific and repetitive response in the bioelectrical activity. In addition, cerebral perfusion changes directly related to the epileptogenic region may serve therefore as a diagnostic tool in the near future.
Authors: Ivan Herrera-Peco; Rybel Wix Ramos; Luis Domínguez-Gadea; María Luisa Meilán; José Luis Martínez-Chacón; Eva de Dios; Rafael G Sola; Jesús Pastor Journal: Epilepsy Res Treat Date: 2010-06-22