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Functional neuroimaging with SPECT in children with partial epilepsy
1Department of Neurology, Royal Children's Hospital, Melbourne, Australia.
Insights
Single-photon emission computed tomography (SPECT) helps pinpoint seizure origins in children. Ictal SPECT, capturing blood flow during seizures, offers greater accuracy than interictal scans for localizing epileptic foci.
Area of Science:
- Neurology
- Radiology
- Pediatrics
Background:
- Intractable partial seizures in children require precise localization for effective treatment.
- Single-photon emission computed tomography (SPECT) is an emerging imaging modality in pediatric epilepsy.
Purpose of the Study:
- To evaluate the role and effectiveness of SPECT in localizing seizure foci in children with intractable partial epilepsy.
- To compare the diagnostic accuracy of ictal versus interictal SPECT.
Main Methods:
- SPECT imaging of regional cerebral blood flow using radiopharmaceuticals like 99mTc-HMPAO.
- Administration of radiopharmaceuticals during interictal and ictal periods.
- Analysis of neuroreceptor binding patterns using specific ligands.
Main Results:
- SPECT typically shows decreased cortical perfusion interictally and increased perfusion ictally at the epileptic focus.
- Ictal SPECT injection demonstrates significantly higher sensitivity and specificity compared to interictal SPECT.
- Altered neuroreceptor binding is observed in the seizure focus region.
Conclusions:
- SPECT is a valuable tool for presurgical localization of seizure foci in pediatric epilepsy.
- Ictal SPECT provides more reliable localization information than interictal SPECT.
- SPECT offers insights into the functional neuroanatomy and neuropharmacology of childhood partial epilepsy.
Abstract:
Single-photon emission computed tomography (SPECT) is being used increasingly in the investigation of children with intractable partial seizures. SPECT imaging of regional cerebral blood flow with 99mTc-hexamethylpropylene amine oxime, iodinated radiopharmaceuticals, and 133Xe typically reveals decreased cortical perfusion interictally and increased cortical perfusion ictally in the region of the epileptic focus. Studies in both adults and children indicate significantly greater sensitivity and specificity with ictal injection of radiopharmaceutical, with interictal SPECT not infrequently revealing nonlocalizing or falsely localizing information. Recent SPECT studies employing iodinated neuroreceptor ligands report altered receptor binding in the region of the epileptic focus, providing insight into the underlying neuropharmacology of partial epilepsy. SPECT has an established role in the presurgical localization of seizure foci in children with intractable partial seizures and may be a useful modality to study the functional anatomy and clinical semiology of partial seizures in childhood.