G Imataka, M Ogino, S Sakamoto, O Arisaka

Abstract

Meticulous neuroradiological evaluations, including ¹²³I-iomazenil (IMZ) single photon emission computed tomography (SPECT) and ¹¹C-flumazenil (FMZ) positron emission tomography (PET), preoperatively disclosed epileptogenic foci in a 16-year-old boy with temporal lobe epilepsy. Interictal scalp electroencephalography showed spikes in the left temporal region. Left hippocampal sclerosis was seen on magnetic resonance imaging. Hypoperfusion in the entire left temporal lobe was seen on ^99mTc ethyl-cysteinate dimer (ECD) SPECT. Hypometabolism over most of the left temporal lobe was apparent on ¹⁸F-fluorodeoxyglucose (FDG) PET. An area of hypoperfusion dominating the left temporal lobe was identified on ¹²³I-IMZ SPECT. A low-uptake area in the left temporal lobe was seen on ¹¹C-FMZ PET. Anteromedial temporal lobectomy and multiple subpial transection with intraoperative electrocorticography resulted in satisfactory seizure outcomes. Use of ¹²³I-IMZ SPECT and ¹¹C-FMZ PET appeared to demonstrate the epilepsy focus more localised than ^99mTc ECD SPECT and ¹⁸F-FDG PET.