Ictal SPECT in a 16-day-old infant

Neonatal seizures can be difficult to classify according to partial versus generalized onset on the basis of clinical appearance or electroencephalography (EEG). Single-photon emission computed tomography has proven to be useful in adults when adjunctive tests are needed to identify the nature of seizure onset. Although its use has been extended recently to children, the lower age limit at which this technique is useful remains to be established. A case is reported in which ictal Tc-99m HMPAO SPECT of a 16-day-old infant revealed an area of focal hypermetabolism in the right temporal lobe corresponding to an area of focal atrophy revealed by MRI. The EEG of this infant demonstrated multifocal interictal epileptiform abnormalities and an ictal pattern with a generalized onset. This case indicates that ictal SPECT is a useful tool in the evaluation of even the youngest patients with seizures.