Related Experiment Video
Updated: Jul 29, 2026
Stereo-Electro-Encephalo-Graphy (SEEG) With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note
Published on: June 13, 2016
Correlation of SPECT with pathology and seizure outcome in children undergoing epilepsy surgery
L M Hartley1, I Gordon, W Harkness
1Neuroscience Unit, Great Ormond Street Hospital for Children NHS Trust, UK.
Insights
SPECT imaging of regional cerebral blood flow (rCBF) helps identify epilepsy causes in children. Ictal hyperperfusion correlates with specific pathologies like developmental issues and Rasmussen's encephalitis, while interictal hypoperfusion suggests hippocampal sclerosis.
Area of Science:
- Neurology
- Neuroradiology
- Pediatric Epilepsy
Background:
- Single-photon emission computed tomography (SPECT) is used for imaging regional cerebral blood flow (rCBF).
- Its role in presurgical evaluation for epilepsy, particularly in relation to pathology and postsurgical outcomes, requires further exploration.
- Few studies have investigated the correlation between preoperative SPECT findings and histopathological diagnoses or surgical outcomes in pediatric epilepsy patients.
Purpose of the Study:
- To retrospectively evaluate preoperative ictal and interictal rCBF in relation to histopathological diagnosis and postsurgical outcome in children undergoing epilepsy surgery.
- To determine if rCBF patterns correlate with specific underlying pathologies and predict surgical success.
Main Methods:
- Retrospective analysis of 35 children (mean age 9.6 years) who underwent resective epilepsy surgery.
- Evaluation of preoperative ictal and interictal rCBF using SPECT.
- Correlation of rCBF findings with histopathological diagnoses and postsurgical outcomes.
Main Results:
- A correlation was found between ictal hyperperfusion and underlying pathology: developmental pathologies and Rasmussen's encephalitis showed increased perfusion, while hippocampal sclerosis (HS) exhibited interictal hypoperfusion.
- No specific rCBF parameter consistently predicted postsurgical outcome.
- In the HS group, localized ictal rCBF was associated with better outcomes.
- For hemispherectomy cases, SPECT added little information beyond MRI findings.
Conclusions:
- rCBF studies are valuable presurgical tools in pediatric partial epilepsy, especially for pathologies like HS, cortical dysplasia, or inflammatory conditions.
- rCBF imaging offers limited additional value for seizures secondary to benign tumors, cerebral infarcts, or when hemispherectomy is the planned surgery.
- SPECT findings can aid in localizing the seizure focus and understanding underlying pathology in pediatric epilepsy.
Abstract:
SPECT can be used to image regional cerebral blood flow (rCBF) and has been shown to help localize the seizure focus in partial epilepsies as part of the presurgical evaluation. Few studies have explored the possible relation between preoperative SPECT and underlying pathology, or any relation to postsurgical outcome. In this study preoperative ictal and interictal rCBF in relation to the histopathological diagnosis and outcome in a series of 35 children (24 females, 11 males; mean age 9.6 years, age range 11 months to 18 years) who had undergone resective surgery for epilepsy were retrospectively evaluated. A correlation between ictal hyperperfusion and the underlying responsible pathology was shown, with a consistent ictal increase in perfusion in developmental pathologies and Rasmussen's encephalitis, and consistent interictal hypoperfusion in hippocampal sclerosis (HS). No rCBF study parameter appeared to relate to outcome but in the group with HS the best outcome was seen in those with localizing ictal rCBF. The varied group of pathologies from hemispherectomy had excellent outcome but the SPECT findings had little to contribute over the abnormalities detected on MRI. In conclusion, rCBF studies remain a useful presurgical investigation in children with partial epilepsy, especially where HS, cortical dysplasia, or inflammatory disease are the underlying pathology. However, rCBF studies add little to the investigation of children with seizures secondary to benign tumours or cerebral infarcts, or where hemispherectomy is the likely preferred surgical option.
More Related Videos
09:32Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients
Published on: December 18, 2016
10:22Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy
Published on: December 6, 2016
