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Brain perfusion SPECT and EEG findings in children with autism spectrum disorders and medically intractable epilepsy
Masayuki Sasaki1, Eiji Nakagawa, Kenji Sugai
1Department of Child Neurology, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan. masasaki@ncnp.go.jp
Insights
Brain perfusion SPECT imaging identified abnormal brain regions in children with autism spectrum disorder (ASD) and intractable epilepsy. This technique aids in locating epileptic foci and assessing brain function.
Area of Science:
- Neuroimaging
- Pediatric Neurology
- Epileptology
Background:
- Autism spectrum disorder (ASD) and medically intractable epilepsy often co-occur in children.
- Identifying the precise brain regions involved is crucial for surgical treatment planning.
Purpose of the Study:
- To utilize brain perfusion single-photon emission computed tomography (SPECT) to detect abnormal brain regions in children with both ASD and intractable epilepsy.
- To investigate the utility of SPECT in identifying epileptic foci and assessing brain function in this population.
Main Methods:
- Fifteen children (aged 4-16) with ASD and intractable epilepsy underwent multimodal examinations including MRI, ECD-SPECT, EEG, and MEG.
- SPECT results were analyzed using the easy Z-score imaging system (eZIS) and compared to standard images.
- Relationships between eZIS patterns, EEG abnormalities, and clinical symptoms were explored.
Main Results:
- All children exhibited focal abnormal patterns on eZIS and focal spikes on EEG.
- eZIS revealed mixed hypoperfusion patterns, particularly in the prefrontal, medial frontal, anterior cingulate, medial parietal, and anterior temporal cortices.
- SPECT successfully identified epileptic foci, with hypoperfusion correlating with EEG foci in some cases and hyperperfusion in others.
Conclusions:
- Brain perfusion SPECT, particularly with the eZIS system, is effective in detecting abnormal brain regions in children with ASD and intractable epilepsy.
- SPECT aids in both localizing epileptic foci and assessing brain functional status (low or high functioning regions).
Objective:
We performed brain perfusion single-photon emission computed tomography (SPECT) to detect the abnormal brain region in children with both autism spectrum disorders (ASD) and medically intractable epilepsy.
Methods:
Fifteen children aged 4-16 years underwent multimodal examinations (MRI, interictal and/or ictal ECD-SPECT, EEG and MEG) to investigate their indications for surgical treatment. All children were diagnosed with ASD according to DSM-IV criteria and intractable epilepsy. Despite medical treatment for more than a year, all experienced at least one seizure per month. All had no underlying basic disorders. Each SPECT result was statistically analyzed by comparing with standard SPECT images obtained from our institute (easy Z-score imaging system; eZIS). The relationship between the eZIS pattern and EEG abnormalities or clinical symptoms was investigated.
Results:
All children showed focal abnormal patterns on eZIS and focal spikes on EEG. In all children, eZIS revealed a mixed hypoperfusion pattern, especially in the prefrontal cortex, medial frontal cortex, anterior cingulate cortex, medial parietal cortex, and/or anterior temporal cortex. In seven of 12 children who underwent interictal SPECT studies, areas of hypoperfusion were related to the focus observed on EEG; in six children, the focal EEG spikes represented areas of hyperperfusion. The children were divided into two groups according to the main type of hypoperfusion patterns seen on eZIS; medial-cingulate type and temporal type. No significant relationship was observed between the areas of hypoperfusion and clinical symptoms. eZIS showed the epileptic focus clearly on ictal SPECT.
Conclusions:
SPECT was useful to detect the abnormal brain region not only in searching for the epileptic focus but also in assessing the low or high functioning region of the brain.
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