Ictal 99mTc-HMPAO single photon emission computed tomography in children with temporal lobe epilepsy

Area of Science:

• Neurology
• Nuclear Medicine

Background:

• Temporal lobe epilepsy (TLE) is a common neurological disorder.
• Accurate localization of the epileptic focus is crucial for effective treatment, particularly surgical intervention.

Purpose of the Study:

• To evaluate the efficacy of ictal technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) single photon emission computed tomography (SPECT) in localizing the seizure onset zone in pediatric patients with TLE.
• To compare the diagnostic utility of ictal SPECT with electroencephalography (EEG) and magnetic resonance imaging (MRI).

Main Methods:

• Seventeen ictal 99mTc-HMPAO SPECT studies were conducted in 15 children (aged 7-14 years) diagnosed with TLE.
• SPECT findings were analyzed visually and quantitatively.
• Results were correlated with ictal EEG, MRI, and pathological data.

Main Results:

• Ictal SPECT was highly informative (94% of studies), demonstrating unilateral temporal lobe hyperperfusion in 14 of 15 children.
• Lateralization of the epileptic focus by ictal SPECT was concordant with EEG, MRI, and pathology in all informative studies.
• Ictal SPECT provided additional localizing information in 4 children not evident from ictal EEG alone.
• Interictal SPECT showed variable hypoperfusion, often less specific than ictal findings.

Conclusions:

• Ictal 99mTc-HMPAO SPECT is a reliable and effective tool for lateralizing the epileptic focus in children with TLE.
• It serves as a valuable adjunct to surface EEG and MRI, offering crucial supplementary information for diagnosis and treatment planning.