Nuclear neuroimaging in childhood epilepsy syndromes: A systematic review

Childhood epilepsy syndromes (CES) are a group of epilepsy disorders with significant variability in prognosis, treatment, and underlying etiology. This systematic review aims to shed light on the role of nuclear brain imaging in diagnosis, pretreatment assessment, and understanding pathophysiology.

A comprehensive search of PubMed, Embase, Scopus, and Web of Science was conducted to identify studies evaluating positron emission tomography (PET) and single-photon emission computed tomography (SPECT) in CES. A risk of bias assessment was performed using the Newcastle-Ottawa Scale.

A total of 100 studies were analyzed. PET was the most utilized modality (65%), with the most common radiotracer being fluorine-18 fluorodeoxyglucose ([¹⁸F]FDG). PET findings highlighted metabolic abnormalities correlating with seizure foci and surgical outcomes, while SPECT provided critical insights into perfusion changes during ictal, interictal, and postictal phases. Multimodal imaging techniques, such as PET combined with magnetic resonance imaging (PET/MRI) and subtraction ictal SPECT co-registered to MRI (SISCOM), further enhanced diagnostic accuracy.

This study highlights the key role of PET and SPECT imaging in childhood epilepsy syndromes, particularly in localizing epileptogenic zones (EZ) when magnetic resonance imaging (MRI) and electroencephalography (EEG) are inconclusive. Nuclear imaging expands understanding of pathophysiology and disease progression in many syndromes, including childhood absence epilepsy (CAE), benign Rolandic epilepsy (BRE), Sturge-Weber syndrome (SWS), Dravet syndrome (DS), Landau-Kleffner syndrome (LKS), and Lennox-Gastaut syndrome (LGS). In conditions such as focal cortical dysplasia and tuberous sclerosis complex, nuclear neuroimaging effectively guides surgical decisions by accurately localizing the EZ.