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[Comparison of modern diagnostic methods in children with intractable focal epilepsy]
E Skorupska1, W Słuzewski, P Bourguet
1Klinika Obserwacyjno-Zakaźna, Akademia Medyczna im. Karola Marcinkowskiego w Poznaniu.
Insights
This study shows that ictal SPECT is highly effective for pinpointing the epileptogenic zone in children with intractable focal epilepsy. Combining ictal and interictal SPECT offers comprehensive data for treatment planning.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Epileptology
Background:
- Intractable focal epilepsy in children requires precise localization of the epileptogenic zone for effective treatment.
- Neuroimaging plays a crucial role in identifying the source of seizures.
Observation:
- This study examined 34 children (aged 11-17) with intractable focal epilepsy using clinical evaluation, EEG, CT, MR, and 99mTc-HMPAO SPECT.
- Interictal SPECT showed hypoperfusion concordant with clinical seizure characteristics in 22 children, EEG in 13, and MR in 13.
- Ictal SPECT revealed hyperperfusion concordant with clinical seizure characteristics in 9/10 children, EEG in 7, and MR in 8.
Findings:
- Interictal SPECT (63%) had diagnostic value comparable to EEG (56%) and MR (59%) for epileptogenic zone localization.
- Ictal SPECT demonstrated superior diagnostic value (100%) compared to interictal SPECT, EEG, and MR.
- Ictal SPECT provided more comprehensive information regarding seizure origin.
Implications:
- Performing both ictal and interictal SPECT studies is recommended for a thorough understanding of seizure origin and its relationship to brain structure.
- Ictal SPECT is a valuable tool for precisely localizing the epileptogenic zone in pediatric epilepsy.
- These findings can guide surgical or therapeutic interventions for children with intractable focal epilepsy.
Abstract:
The basic aim of neuroimaging in children with intractable focal epilepsy is stablishing localization of epileptogenic zone. In this study 34 children (age 11-17 years) with intractable focal epilepsy were examined including: clinical history, physical examination, EEG, CT, MR, 99mTc-HMPAO SPECT. The hypoperfused region in interictal SPECT was concordant with clinical seizure characteristics in 22 children, with EEG in 13, with MR with 13 children. The localization of hyperperfused region in ictal SPECT was concordant with the clinical seizure characteristics in 9 from 10 examined children, with EEG in 7 and with MR in 8. The diagnostic value of estimation of the localization of epileptogenic zone in interictal SPECT (63 per cent) was comparable with the results of EEG (56 per cent) and MR (59 per cent), but ictal SPECT offers more information (100 per cent). In conclusion, performing both ictal and interictal SPECT studies may provide data about both seizure origin and its relationship with structurally abnormal regions of the brain.