Does technetium-99m bicisate image local brain metabolism in late ictal temporal lobe epilepsy?

Eur J Nucl Med. 1994 Nov;21(11):1247-51. doi: 10.1007/BF00182362.


Ictal increase in regional cerebral blood flow as judged by single-photon emission tomography (SPET) is a common phenomenon during focal epileptic seizures. Up to 2 min postictally, regional hyperperfusion is a consistent finding with technetium-99m hexamethylpropylene amine oxime (HMPAO) in temporal lobe epilepsy. A new 99mTc-labelled lipophilic cerebral blood flow imaging agent, bicisate, has considerably longer radiochemical stability and yields better image quality than 99mTc-HMPAO. In this report, we present the case of a 21-year-old female patient with temporal lobe complex partial seizures. Magnetic resonance imaging revealed right hippocampal sclerosis. A dose of 550 MBq of 99mTc-bicisate was injected 35 s after the onset of a seizure during intracranial EEG-videotelemetry. At the moment of injection, subdural EEG demonstrated the beginning of late ictal discharges and postictal suppression in the right temporomesial areas. Late ictal SPET images showed marked right fronto-temporo-parietal hypoactivity. The interictal SPET study clearly showed right frontotemporal hypoactivity. These preliminary data suggest that 99mTc-bicisate shows late ictal/early postictal hypoactivity which might represent the primary change in neuronal metabolism rather than the secondary change in cerebral blood flow.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Brain / diagnostic imaging*
  • Brain / metabolism
  • Cerebrovascular Circulation / physiology
  • Cysteine* / analogs & derivatives*
  • Electroencephalography
  • Epilepsy, Temporal Lobe / diagnostic imaging*
  • Epilepsy, Temporal Lobe / metabolism
  • Female
  • Humans
  • Organotechnetium Compounds*
  • Oximes
  • Technetium Tc 99m Exametazime
  • Time Factors
  • Tomography, Emission-Computed, Single-Photon*


  • Organotechnetium Compounds
  • Oximes
  • Technetium Tc 99m Exametazime
  • technetium Tc 99m bicisate
  • Cysteine