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Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Ictal SPECT is useful in localizing the epileptogenic zone in infants with cortical dysplasia
Martin Kudr1, Pavel Krsek1, Bruno Maton2
1Department of Pediatric Neurology, Charles University, 2nd Faculty of Medicine, University Hospital Motol, Prague, Czech Republic.
Insights
Ictal SPECT imaging aids in localizing epilepsy in infants with focal cortical dysplasia (FCD). Complete resection of hyperperfused areas identified by SPECT correlates with seizure freedom, potentially reducing the need for invasive EEG.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Epilepsy Surgery
Background:
- Intractable focal epilepsy in infants, often caused by focal cortical dysplasia (FCD), presents diagnostic challenges.
- Cerebral haemodynamic responses in very young children are immature, potentially affecting the reliability of neuroimaging techniques.
- Accurate localization of the epileptogenic zone is crucial for successful epilepsy surgery outcomes.
Purpose of the Study:
- To evaluate the diagnostic utility of ictal single-photon-emission computed tomography (SPECT) for localizing the seizure onset zone in infants undergoing epilepsy surgery.
- To assess the correlation between the completeness of resection of identified hyperperfusion zones and postoperative seizure control.
- To determine if ictal SPECT can guide surgical decisions and potentially minimize the need for invasive electroencephalography (EEG) monitoring.
Main Methods:
- Retrospective analysis of 13 infants with intractable focal epilepsy due to FCD.
- Correlation of postoperative seizure outcome with the completeness of resection of the ictal SPECT hyperperfusion zone.
- Comparison with the resection of the MRI/intracranial EEG (iEEG)-defined epileptogenic region.
Main Results:
- Complete resection of the ictal SPECT hyperperfusion zone was significantly associated with seizure freedom (5/5 patients) compared to incomplete or no resection (1/8 patients, p=0.00843).
- Similar positive outcomes were observed for complete resection of the MRI/iEEG-defined epileptogenic region (5/6 seizure-free vs. 1/7 incomplete resection, p=0.02914).
- Patients with complete resection of both regions achieved complete seizure control (4/4), while none of those with incomplete resection did (0/6, p=0.01179).
Conclusions:
- Ictal SPECT provides valuable localization information in infants with FCD, despite immature cerebral perfusion.
- Complete surgical removal of the hyperperfused region identified by ictal SPECT is a strong predictor of favorable seizure outcomes.
- Ictal SPECT may reduce the necessity for invasive EEG evaluations in select pediatric epilepsy surgery candidates.
Aims:
To assess the localizing value of ictal SPECT in very young epilepsy surgery candidates when cerebral haemodynamic responses are known to be immature.
Methods:
We retrospectively studied 13 infants with intractable focal epilepsy caused by focal cortical dysplasia (FCD). Completeness of resection of the (1) ictal SPECT hyperperfusion zone and (2) cerebral cortex with prominent ictal and interictal abnormalities on intracranial EEG (ECoG or long-term invasive monitoring) and the MRI lesion, when present, were correlated with postoperative seizure outcome.
Results:
All five patients with complete resection of the ictal SPECT hyperperfusion zone were seizure-free compared to only one of eight patients with incomplete or no excision of hyperperfusion zones (p=0.00843). Similar results were noted for the MRI/iEEG-defined epileptogenic region; five of six patients with complete removal were seizure-free, whereas only one of seven incompletely resected patients was seizure-free (p=0.02914). All four patients who underwent complete resection of both regions were seizure-free compared to none of the six with incomplete resection (p=0.01179).
Conclusion:
Despite age-related differences in cerebral perfusion, ictal SPECT provides useful localization data in infants with FCD. Complete resection of the hyperperfused regions is a strong predictor of favourable outcome. The added information may alleviate the need for invasive EEG evaluations in some patients.
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