Related Experiment Videos
Infantile spasms: cerebral blood flow abnormalities correlate with EEG, neuroimaging, and pathologic findings
1Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
This study found that 85% of children with infantile spasms have abnormal cerebral blood flow (CBF). Identifying and surgically removing focal cortical lesions can improve seizure control in these infants.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Epileptology
Background:
- Infantile spasms (IS) are a severe epilepsy syndrome in infants.
- Understanding the underlying causes and neurophysiological correlates of IS is crucial for effective management.
Purpose of the Study:
- To investigate cerebral perfusion abnormalities in children with infantile spasms.
- To correlate cerebral blood flow (CBF) findings with electroencephalography (EEG), neuroimaging, and pathology.
- To explore the role of focal cortical lesions in IS and their surgical management.
Main Methods:
- Cerebral perfusion studies using 99Tc-HmPAO SPECT in 20 infants with IS.
- Correlated SPECT findings with CT/MRI, EEG, and surgical pathology.
- Analyzed CBF abnormalities in relation to etiology (dysgenesis, tuberous sclerosis, etc.) and cryptogenic cases.
Main Results:
- 85% of patients exhibited CBF abnormalities, including multifocal and focal decreases/increases.
- Symptomatic IS causes included cerebral dysgenesis (33%), congenital lesions (25%), and tuberous sclerosis (17%).
- Focal cortical lesions were identified as potential causes, even in cryptogenic IS, via functional neuroimaging.
Conclusions:
- Abnormal cerebral blood flow is common in infantile spasms.
- Functional neuroimaging, like 99Tc-HmPAO SPECT, can help localize focal cortical lesions.
- Surgical excision of identified lesions may improve seizure control and outcomes in selected IS patients.
Abstract:
This ongoing study examines abnormalities of cerebral perfusion in a consecutive series of children with infantile spasms and correlates cerebral blood flow (CBF) abnormalities with electroencephalographic (EEG), neuroimaging, and pathologic findings. A consecutive series of children with infantile spasms, diagnosed by standard clinical and EEG criteria, had cerebral perfusion studies using 99Tc-HmPAO single photon emission computed tomography (SPECT), together with neuroimaging studies using computed tomography (CT) and/or magnetic resonance imaging (MRI), interpreted independently and correlated with surgical pathologic findings. Twenty children aged 2-13 months (mean 9.3 months) were studied over a 4-year period; 60% had symptomatic infantile spasms due to cerebral dysgenesis (33%), other congenital lesions (25%), tuberous sclerosis (17%), or other causes (25%), and the remaining patients were cryptogenic (40%). CBF abnormalities were present in 85%: multifocal decrease (40%), focal increase (25%), diffuse decrease (15%), and focal increase (10%), while the remaining 15% had normal cerebral blood flow. Focal cortical lesions may lead to infantile spasms, even in cryptogenic patients diagnosed by functional neuroimaging such as 99Tc-HmPAO SPECT. In selected patients, surgical excision of the cortical lesions leads to improved seizure control and possibly outcome. The localization and surgical excision of focal cortical lesions in infantile spasms required further investigation with functional and structural neuroimaging, EEG, and intraoperative electrocorticography.