Tc-99m HMPAO brain scintigraphy in children with partial epilepsy

The aim of this article is to verify if SPECT is useful for better classification and therapy of pediatric partial epilepsy when clinical findings, electroencephalogram (EEG), and neuroimaging are inconclusive. Twenty patients, who ranged in age from 9 months to 17 years, were studied qualitatively and semiquantitatively by Tc-99m HMPAO SPECT during the interictal phase. SPECT demonstrated areas of reduced cerebral perfusion in all patients. In four patients, SPECT agreed with the clinical and electroencephalographic data. In eight patients with generalized anomalies on EEG, SPECT showed focal hypoperfusion in accord with the clinical findings. In four patients, SPECT agreed only with the EEG findings. In the remaining four patients, SPECT findings, inconsistent with clinical and EEG data, did not improve the diagnostic accuracy. Semiquantitative analysis does not modify the scintigraphic information. SPECT was particularly useful in borderline cases. The identification of localized hypoperfusion areas in patients with generalized seizures, either primary or secondary, but with focal EEG abnormalities, confirms the possibility of seizures of focal origin. In pediatric patients with partial epilepsy, SPECT is able to detect changes in cerebral blood flow which probably correspond to the epileptogenic foci. It can influence the prognosis and the therapy when the results of EEG and neuroradiologic examinations are nonspecific or negative.