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Ictal SPECT in children with partial epilepsy due to focal cortical dysplasia

Ajay Gupta1, Shankar Raja, Prakash Kotagal

  • 1Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

Pediatric Neurology
|August 11, 2004
PubMed

Insights

Ictal single-photon emission computed tomography (SPECT) aids in presurgical evaluation for pediatric partial epilepsy due to focal cortical dysplasia. Localized SPECT findings correlate with better seizure-free outcomes post-surgery, particularly when MRI is normal.

Area of Science:

  • Pediatric Neurology
  • Epileptology
  • Neuroradiology

Background:

  • Partial epilepsy in children often stems from focal cortical dysplasia (FCD).
  • Accurate presurgical evaluation is crucial for successful surgical resection in refractory epilepsy.
  • Limitations exist in standard neuroimaging, like magnetic resonance imaging (MRI), for detecting FCD.

Purpose of the Study:

  • To assess the utility of ictal single-photon emission computed tomography (SPECT) in presurgical evaluation of pediatric partial epilepsy caused by FCD.
  • To correlate ictal SPECT findings with surgical outcomes and other neuroimaging modalities.

Main Methods:

  • Retrospective analysis of 15 children (age 1-18 years) with FCD-related partial epilepsy undergoing presurgical evaluation.
  • Subtraction ictal SPECT and brain positron emission tomography (PET) were performed and findings classified as localized, nonconcordant, or nonlocalized.
  • Comparison of ictal SPECT and PET localization with MRI findings and surgical resection sites.

Main Results:

  • Ictal SPECT localized hyperperfusion in 8 of 15 patients; PET localized in 9 patients.
  • In patients with normal MRI, ictal SPECT localized in 3 of 4 cases.
  • Seizure freedom at follow-up was higher in patients with localized ictal SPECT (6/7, 85%) compared to nonconcordant/nonlocalized cases (4/7, 57%).

Conclusions:

  • Ictal SPECT is a valuable adjunctive tool in the presurgical workup of pediatric refractory partial epilepsy due to FCD.
  • Its usefulness is particularly pronounced when MRI findings are normal or inconclusive.
  • Localized ictal SPECT findings are associated with improved post-surgical seizure control.

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