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Children with intractable focal epilepsy: ictal and interictal 99TcM HMPAO single photon emission computed tomography
J H Cross1, I Gordon, G D Jackson
1Wolfson Centre, London, UK.
Insights
This study shows that technetium Tc-99m HMPAO SPECT scans can help locate seizure origins in children. Combining ictal and interictal scans provides the most reliable data for pinpointing seizure focus.
Area of Science:
- Neurology
- Nuclear Medicine
- Medical Imaging
Background:
- Intractable complex partial seizures in children pose diagnostic challenges.
- Accurate localization of seizure foci is crucial for effective treatment.
Purpose of the Study:
- To evaluate the utility of technetium Tc-99m HMPAO single photon emission computed tomography (SPECT) in localizing seizure foci in pediatric patients.
- To compare ictal and interictal SPECT findings for seizure localization.
Main Methods:
- Fourteen children with intractable complex partial seizures underwent both ictal and interictal 99TcM HMPAO SPECT scans.
- Analysis focused on regional cerebral blood flow (rCBF) patterns.
- Correlation with clinical and electroencephalogram (EEG) data was performed.
Main Results:
- Abnormalities concordant with clinical/EEG localization were found in 13 out of 14 patients.
- Ictal scans showed focal hyperperfusion at the seizure focus.
- Interictal scans revealed focal hypoperfusion.
- Significant changes in rCBF patterns between ictal and interictal scans were key for reliable localization.
Conclusions:
- 99TcM HMPAO SPECT, particularly when combining ictal and interictal studies, is a valuable tool for localizing seizure origins in children.
- The timing of radiotracer injection relative to seizure onset is critical for accurate results.
- This technique can provide information on both seizure origin and its relationship to brain structure.
Abstract:
Fourteen children with intractable complex partial seizures underwent ictal and interictal 99TcM HMPAO single photon emission computed tomography (SPECT) scans. Abnormalities concordant with clinical and/or EEG localisation were present in 13 of 14 ictal and/or interictal scans. Focal hyperperfusion was seen at the seizure focus on ictal scans and focal hypoperfusion was seen on interictal scans. The timing of the injection in relation to the start of the seizure was crucial for reliable localisation. While recognisable patterns of regional cerebral blood flow (rCBF) were seen on either interictal or ictal scans, marked changes in the patterns of rCBF between the ictal study and interictal study provided the most reliable information about seizure localisation. Using both ictal and interictal studies, 99TcM HMPAO SPECT may provide data about both the seizure origin and its relationship to structurally abnormal regions of the brain.