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[Time-course changes of regional cerebral blood flow by SPECT with N-isopropyl-p-[123I]-iodoamphetamine in childhood
N Michihiro1, M Ariizumi, H Shiihara
1Department of Pediatrics, Dokkyo University School of Medicine, Koshigaya Hospital, Saitama.
Insights
Repeated Single Photon Emission Computed Tomography (SPECT) in children with partial seizures shows changes in regional cerebral blood flow (CBF). Improved CBF correlates with seizure control, indicating SPECT
Area of Science:
- Neurology
- Nuclear Medicine
- Pediatrics
Background:
- Partial seizures in children can involve complex hemodynamic changes.
- Understanding regional cerebral blood flow (CBF) dynamics is crucial for epilepsy management.
Purpose of the Study:
- To evaluate time-course changes in regional CBF using repeated SPECT in pediatric partial seizures.
- To assess the utility of SPECT in monitoring therapeutic efficacy and understanding seizure pathophysiology.
Main Methods:
- 18 children with partial seizures underwent two SPECT scans using N-isopropyl-p-[123I]-iodoamphetamine at different times.
- Regional CBF was analyzed for changes, including normalization, contraction, or persistence of decreased flow.
- Correlation with clinical seizure frequency and EEG findings was performed.
Main Results:
- A significant proportion of patients showed normalization or contraction of decreased CBF after treatment.
- Improved CBF correlated with seizure disappearance and normalized EEG findings.
- Unchanged decreased CBF was observed in patients with frequent or uncontrolled seizures and persistent EEG abnormalities.
Conclusions:
- Repeated SPECT is a valuable tool for assessing therapeutic response in pediatric partial seizures.
- SPECT can help guide treatment decisions and elucidate the pathogenetic mechanisms of epileptic foci.
- Monitoring regional CBF dynamics provides insights into the underlying condition of epileptic foci.
Abstract:
Single photon emission computed tomography (SPECT) with N-isopropyl-p-[123I]-iodoamphetamine was performed twice at different times in 18 children suffering from partial seizures to evaluate the time-course changes of the hemodynamics in the focal region. Comparison of the 2 SPECT images revealed that a decreased regional cerebral blood flow (CBF) in the first was normalized in 4 cases (22.2%) and contracted in 7 cases (38.9%). The region of decreased blood flow in the second was contralateral to that in the first in 1 case (5.6%) and unchanged in 6 cases (33.3%). Most of the normalized and contracted cases were those in which clinical seizures disappeared and the EEG findings were normalized. In these cases which responded to treatment, the decreased regional CBF was also found to be improved. Repeated SPECT appears to be useful for evaluating the therapeutic efficacy. On the other hand, most of the unchanged cases were those in which clinical seizures were frequent or uncontrolled, or which persistently showed the abnormalities in their EEG. SPECT was considered to reflect well the conditions of the epileptic foci. These results indicate that repeated SPECT for observing the time-course changes of the regional CBF represents a useful technique with can be applied in evaluating the therapeutic efficacy or deciding the time to discontinue treatment and for pathogenetic elucidation of the epileptic foci.