Surgery for intractable infantile spasms: neuroimaging perspectives

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Epileptology

Background:

• Intractable infantile spasms pose significant challenges in pediatric epilepsy management.
• Identifying the epileptogenic zone is crucial for successful surgical intervention.

Purpose of the Study:

• To evaluate the efficacy of surgical interventions, specifically cortical resection and hemispherectomy, for intractable infantile spasms in infants and children.
• To assess the role of neuroimaging, including MRI and PET, in localizing the epileptogenic cortex for surgical planning.

Main Methods:

• Retrospective analysis of 23 infants and children who underwent epilepsy surgery for intractable infantile spasms.
• Utilized magnetic resonance imaging (MRI) and positron emission tomography (PET) for neuroimaging.
• Correlated neuroimaging findings with neuropathological examination of resected tissue and electrographic abnormalities.

Main Results:

• Fifteen out of 23 patients (65%) became seizure-free post-surgery.
• An additional four patients achieved substantial seizure reduction (90% or 75% control).
• PET was essential in localizing the epileptogenic cortex in 14 patients, often when MRI was inconclusive.

Conclusions:

• Epilepsy surgery, including cortical resection and hemispherectomy, is an effective treatment for intractable infantile spasms.
• Advanced neuroimaging techniques like PET play a vital role in identifying the seizure focus in pediatric epilepsy.
• Surgical intervention can lead to long-term seizure freedom or significant seizure control in a majority of affected children.