Effect of automatic injectors on the injection latency, safety, and seizure onset zone localization of ictal single photon emission computed tomography studies in adult epilepsy monitoring unit

Ahmed Yassin; Abdel-Hameed Al-Mistarehi; Khalid El-Salem; Alexandra Urban; Cheryl Plummer; Seyed Mohammadi; Arun R Antony; Gena R Ghearing; James M Mountz; Anto I Bagić

doi:10.1016/j.eplepsyres.2020.106522

Effect of automatic injectors on the injection latency, safety, and seizure onset zone localization of ictal single photon emission computed tomography studies in adult epilepsy monitoring unit

Epilepsy Res. 2021 Jan:169:106522. doi: 10.1016/j.eplepsyres.2020.106522. Epub 2020 Dec 1.

Authors

Affiliations

¹ Division of Neurology, Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan. Electronic address: amyassin@just.edu.jo.
² Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan. Electronic address: awalmistarehi18@med.just.edu.jo.
³ Division of Neurology, Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan. Electronic address: kelsalem@just.edu.jo.
⁴ Division of Epilepsy, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: urbana1@upmc.edu.
⁵ Division of Epilepsy, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: PlummerC@upmc.edu.
⁶ Division of Nuclear Medicine, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: mohammadis2@upmc.edu.
⁷ Division of Epilepsy, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: antonya2@upmc.edu.
⁸ Department of Neurology, The University of Iowa, IA, USA. Electronic address: gena-ghearing@uiowa.edu.
⁹ Division of Nuclear Medicine, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: mountzjm@upmc.edu.
¹⁰ Division of Epilepsy, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: bagica@upmc.edu.

PMID: 33296809
DOI: 10.1016/j.eplepsyres.2020.106522

Abstract

Background: Ictal Single Photon Emission Computed Tomography (iSPECT) is one of the established tools utilized in the presurgical evaluation of patients with drug-resistant epilepsy (DRE). Timely isotope injection for an iSPECT is critical for optimal yield but poses logistical challenges when done manually. We aim to evaluate the added value of automatic iSPECT injectors (ASIs) in overcoming such challenges.

Methods: We retrospectively reviewed all cases admitted to the University of Pittsburgh Medical Center (UPMC) Epilepsy Monitoring Unit from Jan 1, 2010, through Dec 31, 2016, who underwent an iSPECT. We compared the manually injected iSPECTs with those performed with ASIs.

Results: A total of 123 iSPECTs were reviewed. The manually injected iSPECT group consisted of 35 patients (median age, 35 years; and 19 males). The automatically injected iSPECT group consisted of 88 patients (median age, 36 years; and 46 males). The two groups were comparable in age, gender, epilepsy treatment, focal features on neuropsychological testing (NPT), EEG, and MRI, and temporal origin of seizures (p > 0.05). Compared to manually injected iSPECTs, automatically injected ISPECTs' median injection latency (IL) was shorter (18.5 vs. 60 s, p < 0.001); the ratio of IL/total duration of seizure was lower (0.395 vs. 0.677, p < 0.001); postictal injections were less frequent (4 (4.5 %) vs. 7 (20 %), p = 0.007); the number of isotope spills was less (zero vs. 3, p = 0.022); and successfully localizing iSPECTs were more prevalent (81.8 % vs. 62.9 %, p = 0.025), even after adjusting for focal features on NPT, EEG, and MRI, the temporal origin of seizures, and seizure duration (OR of 5.539, 95 %CI = 1.653-18.563, p = 0.006).

Conclusions: Utilization of ASIs leads to a significant shortening of iSPECT IL with less postictal injections, provides a safer injection option for the EMU staff, and leads to a significant improvement in the number of successfully localizing iSPECTs.

Keywords: Adults; Automatic injector; Epilepsy; Ictal SPECT.

MeSH terms

Adult
Electroencephalography*
Epilepsy*
Humans
Magnetic Resonance Imaging
Male
Retrospective Studies
Seizures* / diagnostic imaging
Tomography, Emission-Computed, Single-Photon