Ictal Hyperperfusion of Cerebellum and Basal Ganglia in Temporal Lobe Epilepsy: SPECT Subtraction with MRI Coregistration

The ictal hyperperfusion (compared with the interictal state) of the cerebellum and basal ganglia has not been investigated systematically in patients with temporal lobe epilepsy (TLE). Their ictal perfusion patterns were analyzed in relation to tem-poral and frontal hyperperfusion during TLE seizures using SPECT subtraction. Methods: Thirty-three TLE patients had interictal and ictal SPECT, video-electroencephalographic (EEG) monitoring, and volumetric MRI. SPECT subtraction with MRI coregistration was performed using commercial software. The presence of ictal hyperperfusion was determined in the ipsilat-eral and contralateral temporal lobe, frontal lobe, cerebellum, and basal ganglia. Results: All patients showed ictal hyperper-fusion in the temporal lobe of seizure origin. Vermian cerebellar hyperperfusion (CH) was observed in 26 patients (78.8%) and hemispheric CH was found in 25 (75.8%). Compared with th