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[99mTc-HMPAO SPECT in epileptic disorders in childhood]
O Kanazawa1, T Okuno, H Mikawa
1Department of Pediatrics, Faculty of Medicine, Kyoto University.
Insights
Technetium Tc-99m-d,l-hexamethylpropylenamine oxime (HMPAO) SPECT scans revealed reduced regional cerebral blood flow (rCBF) in children with epilepsy. This imaging technique aids in understanding seizure mechanisms and epileptic discharge origins.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Epileptology
Background:
- Epileptic disorders in childhood require accurate etiological investigation.
- Regional cerebral blood flow (rCBF) changes are associated with epileptic activity.
- Technetium Tc-99m-d,l-hexamethylpropylenamine oxime (HMPAO) is a radiotracer used in SPECT imaging.
Observation:
- SPECT scans were performed on two children with epilepsy during sleep and wakefulness.
- One child with partial epilepsy showed decreased rCBF interictally and more significantly postictally.
- Another child with continuous spike-waves during sleep showed decreased rCBF during sleep but not wakefulness.
Findings:
- HMPAO SPECT demonstrated focal decreases in rCBF corresponding to epileptic activity.
- Interictal and immediate postictal SPECT scans in partial epilepsy revealed consistent regions of reduced rCBF.
- SPECT during sleep identified decreased rCBF in a patient with continuous spike-waves, correlating with epileptic discharges.
Implications:
- HMPAO SPECT is a valuable tool for investigating the mechanisms of seizures and epileptic discharges in children.
- This neuroimaging modality can help localize the source of epileptic activity, even in the absence of clinical seizures.
- Findings suggest HMPAO SPECT can aid in the etiological diagnosis and understanding of pediatric epilepsy.
Abstract:
Single photon emission tomography (SPECT) using Tc-99m-d,1-hexamethylpropylenamine oxime (HMPAO) was performed in two children with epileptic disorders during both sleeping and waking diurnal stages. Immediate postictal and interictal SPECT scans were obtained for a child with partial epilepsy. They demonstrated an interictal decrease in the regional cerebral blood flow (rCBF) and a more remarkable immediately postictal decrease in rCBF. The focus was in the same region of the SPECT for both interictal and postictal spikes. Another patient was diagnosed as having continuous spike-waves during slow sleep without epileptic seizures. Although SPECT during wakefulness showed no asymmetry, SPECT during sleep revealed decreased rCBF at the same location as the predominant area of diffuse epileptic discharges. We conclude that HMPAO SPECT is useful in investigation of the etiological mechanisms of seizures and epileptic discharges in epileptic disorders in childhood.