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Doctoral Thesis
DOI
https://doi.org/10.11606/T.82.2017.tde-01122021-164112
Document
Author
Full name
Emerson Nobuyuki Itikawa
Institute/School/College
Knowledge Area
Date of Defense
Published
São Carlos, 2017
Supervisor
Committee
Ana, Lauro Wichert (President)
Murta Junior, Luiz Otavio
Sakamoto, Américo Ceiki
Salmon, Carlos Ernesto Garrido
Santos, Antonio Carlos dos
Title in Portuguese
Contribuição prognóstica da subtração entre os SPECTs crítico e intercrítico e o seu alinhamento com a RM (SISCOM) em pacientes com epilepsia farmacorresistente associada à RM 3T NORMAL
Keywords in Portuguese
Acoplamento neurovascular
Epilepsia refratária
PET
RM normal
SISCOM
SPECT
Abstract in Portuguese
O planejamento pré-cirúrgico visa localizar a zona epileptogênica presumida (ZEP) através da avaliação multidisciplinar que inclui: eletroencefalograma (EEG) ambulatorial, Vídeo-EEG, Tomografia Computadorizada (CT), Imagens por Ressonância Magnética (IRM), SPECTs (tomografia computadorizada por emissão de fóton único) crítico e intercrítico, PET (tomografia por emissão de pósitron) e avaliação neuropsicológica. A IRM é a neuroimagem estrutural de escolha para a investigação de lesões potencialmente epileptogênicas. O problema surge quando a IRM de alto campo é incapaz de revelar quaisquer anormalidades (ie., RM negativa). Nesses casos, o SISCOM tem sido utilizado para revisar a IRM e para implantação de eletrodos invasivos. Os objetivos deste projeto foram: (a) Avaliar a contribuição do SISCOM na avaliação pré-cirúrgica e terapêutica de pacientes com RM 3T negativa; b) Avaliar o acoplamento vascular (ANV) através do SPECT intercrítico e do PET; Este foi um estudo longitudinal, prospectivo, que avaliou a concordância entre o SISCOM e o vídeo-EEG em 40 pacientes com epilepsia refratária e RM 3T negativa. Para avaliar o aporte sanguíneo e o metabolismo neuronal anormal à RM negativa, investigamos o acoplamento neurovascular (ANV) em um subgrupo de 32 pacientes que realizaram o PET cerebral. Os pacientes receberam a administração intravenosa de 1.480MBq de 99mTc-ECD para realização do SPECT crítico/intercrítico. O PET cerebral foi adquirido com atividade de 185 MBq. Os SPECTs e o PET foram alinhados com a IRM 3T multiplanar ponderada em T1. Os achados do SISCOM foram correlacionados com o vídeo-EEG e demais dados da avaliação pré/pós-cirúrgicas. O SISCOM foi a técnica com as maiores taxas de concordância com o vídeo-EEG (81%), seguido do SPECT crítico (56%). Ao verificar a abordagem proposta pela equipe em reunião clínica, a área de abordagem invasiva foi mais restrita em 75% dos casos em que o SISCOM foi concordante com o vídeo-EEG. Dentre os pacientes com bom resultado cirúrgico, o foco do SISCOM foi completamente ressecado em 50% dos pacientes. Dentre os pacientes com mau resultado cirúrgico, o foco do SISCOM não foi ressecado em 75% dos pacientes. A análise do PET e do SPECT intercrítico mostrou mudanças de acoplamento entre o aporte sanguíneo e o metabolismo neuronal no período intercrítico. Concluímos que o SISCOM contribuiu para a hipótese diagnóstica da ZE através de uma investigação mais topograficamente seletiva através do EEG invasivo. O estudo fisiopatológico da epilepsia refratária com IRM negativa evidenciou mudanças de acoplamento perfusional e metabólico no período intercrítico.
Title in English
Prognostic contribution of subtraction between ictal and interictal SPECT and its alignment to MRI (SISCOM) in patients with pharmacorresistant epilepsy associated to normal 3T MRI
Keywords in English
Neurovascular coupling
Normal MRI
PET
Refractory epilepsy
SISCOM
SPECT
Abstract in English
Presurgical evaluation aims to localize the presumed epileptogenic zone (PEZ) through a multidisciplinary evaluation that includes: ambulatory electroencephalogram (EEG), Video-EEG, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), ictal and interictal SPECTs, PET (positron emission tomography) and neuropsychological evaluation. The MRI is the structural neuroimaging of choice for investigation of potentially epileptogenic lesions. The problem arises when a high-field MRI is unable to reveal abnormalities (i.e. negative MRI). In these cases, SISCOM has been used to review an MRI and for implantation of invasive electrodes. The objectives of this project were: (a) To evaluate the contribution of SISCOM in the presurgical and therapeutic evaluation of patients with negative-3T MRI; b) To evaluate the neurovascular coupling (NVC) through the interictal SPECT and PET; This study assessed the agreement between SISCOM and video-EEG in 40 patients with refractory epilepsy and negative-3T MRI. To assess blood-input and abnormal neuronal metabolism to the negative-MRI, we investigated neurovascular coupling (NVC) in a subgroup of 32 patients who performed brain PET. Patients were intravenously administered with 1,480MBq of 99mTc-ECD for ictal/interictal SPECT. The brain PET was acquired with 185 MBq of activity. The SPECTs and the PET were aligned using a multiplanar T1-weighted MRI. SISCOM findings were correlated with video-EEG and other pre/post-surgical evaluation data. SISCOM was the technique with the highest agreement rates with video-EEG (81%), followed by ictal SPECT (56%). The area of invasive approach proposed by the team from the clinical meeting was more restricted in 75% of cases in which SISCOM was concordant with the video-EEG. Among those patients with good surgical results, the SISCOM focus was completely resected in 50% of the patients. Among those patients with poor surgical outcome, the SISCOM focus was not resected in 75% of the patients. Analysis of PET and interictal SPECT showed changes in the coupling between blood supply and neuronal metabolism in the interictal period. We concluded that SISCOM contributed to the diagnostic hypothesis of EZ with a more topographically selective investigation through invasive-EEG. The pathophysiological study of refractory epilepsy with negative-3T MRI revealed changes in perfusion and metabolic coupling in the interictal period.
 
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Publishing Date
2022-09-13
 
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