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R. Edward Hogan, MD; Kitti Kaiboriboon, MD; Mary E. Bertrand, MD; Venkat Rao, MD; Jayant Acharya, MD

Arch Neurol. 2006;63:1419-1426.

Objective  To compare composite subtraction ictal single-photon emission computed tomography coregistered to magnetic resonance imaging (also known as SISCOM) patterns between right and left medial temporal-onset seizures to document neuroanatomical involvement in perfusion patterns.

Design  A retrospective comparative survey.

Setting  Epilepsy monitoring unit in a tertiary care referral center.

Participants  Subjects with temporal lobe epilepsy (TLE) who underwent ictal single-photon emission computed tomography studies.

Main Outcome Measures  Comparison of ictal perfusion pattern changes in subjects with right and left temporal seizures.

Results  Composite subtraction ictal single-photon emission computed tomography coregistered to magnetic resonance images showed similar regions of hyperperfusion change in the ipsilateral anteromedial temporal–corpus striatum–insula region in both groups. In the midbrain reticular formation, there was a significant difference in hyperperfusion between the left and right TLE groups. In addition, the right, but not the left, TLE group shows contralateral hypoperfusion of the temporoparietal junction.

Conclusions  While anteromedial temporal–corpus striatum–insula perfusion patterns are similar, there are brainstem and hemispheric perfusion pattern differences in right and left TLE seizures, confirming pathophysiological differences between the groups. These findings help define neuronal network involvement in TLE seizures, and may explain the differences in clinical symptoms of right and left TLE seizures.

Author Affiliations: Departments of Neurology, Saint Louis University, St Louis, Mo (Drs Hogan, Bertrand, Rao, and Acharya), and University of California, San Francisco (Dr Kaiboriboon). Dr Hogan is now with the Department of Neurology, Washington University School of Medicine, St Louis.

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