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Cerebral perfusion abnormalities in therapy-resistant epilepsy in childhood: comparison between EEG, MRI and
A Vattimo1, L Burroni, P Bertelli
1Department of Nuclear Medicine, Policlinico Le Scotte, University of Siena, Italy.
Insights
99Tcm-ethyl cysteinate dimer (ECD) single photon emission tomography (SPET) effectively detects brain blood flow abnormalities in children with severe epilepsy. This imaging technique aids in localizing potential epileptic foci, even when magnetic resonance imaging (MRI) is normal.
Area of Science:
- Neurology
- Nuclear Medicine
- Pediatric Epilepsy
Background:
- Epilepsy in children often presents as therapy-resistant.
- Accurate localization of epileptic foci is crucial for effective treatment.
- Conventional neuroimaging may not always identify subtle abnormalities.
Purpose of the Study:
- To evaluate the utility of 99Tcm-ethyl cysteinate dimer (ECD) interictal single photon emission tomography (SPET) in identifying hypoperfused areas in children with severe, therapy-resistant epilepsy.
- To compare SPET findings with electroencephalogram (EEG) and magnetic resonance imaging (MRI).
Main Methods:
- 26 children with severe therapy-resistant epilepsy underwent clinical examination, EEG, MRI, and 99Tcm-ECD SPET.
- Interictal SPET was used to assess brain blood flow patterns.
- Findings from SPET, EEG, and MRI were correlated.
Main Results:
- SPET revealed brain blood flow abnormalities in 21 out of 26 children.
- In 13 cases, SPET abnormalities corresponded to EEG alterations.
- MRI identified structural lesions in 6 children, with SPET confirming 5 of these; one small lesion (3mm) was missed by SPET.
- Five patients with normal SPET had epilepsy, with varied EEG and MRI findings.
Conclusions:
- 99Tcm-ECD SPET is sensitive in detecting and localizing hypoperfused areas associated with epileptic foci in children.
- SPET can identify abnormalities even when MRI scans are normal or reveal subtle lesions.
- This technique is valuable for managing pediatric epilepsy when other methods are inconclusive.
Abstract:
We performed 99Tcm-ethyl cysteinate dimer (ECD) interictal single photon emission tomography (SPET) in 26 children with severe therapy-resistant epilepsy. All the children underwent a detailed clinical examination, an electroencephalogram (EEG) investigation and brain magnetic resonance imaging (MRI). In 21 of the 26 children, SPET demonstrated brain blood flow abnormalities, in 13 cases in the same territories that showed EEG alterations. MRI showed structural lesions in 6 of the 26 children, while SPET imaging confirmed these abnormalities in only 5 children. The lesion not detected on SPET was shown to be 3 mm thick on MRI. Five symptomatic patients had normal SPET. In one of these patients, the EEG findings were normal and MRI revealed a small calcific nodule (4 mm thick); in the others, the EEG showed non-focal but diffuse abnormalities. These data confirm that brain SPET is sensitive in detecting and localizing hypoperfused areas that could be associated with epileptic foci in this group of patients, even when the MRI image is normal.