| Objective Ictal single-photon emission-computed tomography (SPECT) studies improve seizure focus localisation by providing direct information about brain perfusion during seizures.However, truly ictal SPECT studies are not routinely performed owing to technical problems.The aim of this study was to search the feasibility and clinical value of clonidine and deprivation of sleep provoked ictal brain SPECT during seizures in patients with epilepsy.Methods The present study was performed in 52 epileptic patients,who were given oral aplication of clonidine and deprived of sleep to provoke seizures during video-electroencephalogram (video-EEG) minitoring. Technetium-99m ethyl cysteinate dimer (99mTc-ECD) was injected within 30S when a clinical sign and/or an typical EEG discharge was recognised,then brain SPECT was performed after 30min. Meanwhile,47 patients were selected as contrast,who were provoked by deprivation of sleep only.Then x2 test was used in statistical analysis to compare the results of two groups,the software was SPSSlO.O.Results 39(75%) patients provoked seizures between 1 and 2 hour after oral application of clonidine in 52 patients,of whom,36 (92.2%) had subclinical seizures and 3(7.8%) had clinical seizures. Ictal brain SPECT localized in 37(94.9%)patients,of which 35(95%) patients had single hyperperfusion,and 2(5%) had multiple hyperperfusion.In patients who were deprived of sleep only, 38.3%(18/47) provoked epileptic activity, of whom,77.8%(14/18) had subclinical seizures and 22.2%(4/18) had clinical seizures. Clonidine and deprivation of sleep provoked seizures higher than deprivation of sleep only (x2=13.614, P=0.000), and there is no deference in provoked clinical seizures between two groups (x2=1.253,P=0.263). Conclusion The oral administration of clonidine and deprivation of sleep increase the probability of recording epileptic activity during limited acquisition time than deprivation of sleep only,and the former main provokes subclinical seizures.Therefore, clonidine and deprivation of sleep can be considered as an safe and effective method to help obtaining ictal brain SPECT.Objective Identification of the epileptic focus is the most important requirement for a successful surgical outcome in intractable epilepsy. The aim of this study was trying to localize the epileptic focus by means of ictal SPECT and Video-EEG patterns to decide whether the combination of them are capable of localizing epileptic focus correctly.Method The present study was performed in 45 epileptic patients,who showed spike waves during video-EEG minitoring when deprived of sleep to provoke seizures, even oral aplication of clonidine was given when deprivation of sleep was falied in limited time.Technetium-99m ethyl cysteinate dimer (99mTc-ECD) was injected within 30S when a clinical sign and/or an typical EEG discharge was recognised,then brain SPECT was performed after 30min.In the end, compare the results of ictal SPECT and Video-EEG in localization.Result Ictal brain SPECT localized in 93.3%(42/45) patients,of whom 95.2% (40/42) patients had single hyperperfusion,and 4.8%(2/42) had multiple hyperperfusion. Video-EEG showed partial zeizures in 68.9%(31/45) patients,and 31.1%(14/45) patients showed generalized spike waves.The relationship of ictal SPECT and video-EEG in localizing epileptic focus turned out as follow.Firstly, the consistency of ictal SPECT and video-EEG is 83.9%(26/31) in partial zeizure,as for generalized tonic-clonic seizure, video-EEG showed generalized spike waves,and ictal brain SPECT appeared single hyperperfusion,therefore,the localization of them is different.Conclusion The consistency of ictal SPECT and video-EEG in localization has something to do with epilepsy categories.The study indicates that it is possible to obtain localization in patients with partial seizures using a combination of ictal SPECT and video-EEG patterns,as for generalized tonic-clonic seizure, the combination of them is not enough and it's imperative to combine other techniques.
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