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EEG, PET, SPET and MRI in intractable childhood epilepsies: possible surgical correlations
A Fois1, M A Farnetani, P Balestri
1Institute of Clinical Pediatrics, University of Siena, Italy.
Abstract:
Magnetic resonance imaging (MRI), single photon emission tomography (SPET), and positron emission tomography (PET) using [18F]fluorodeoxyglucose were used in combination with scalp and scalp-video EEGs in a group of 30 pediatric patients with drug resistant epilepsy (DRE) in order to identify patients who could benefit from neurosurgical approach. Seizures were classified according to the consensus criteria of The International League Against Epilepsy. In three patients infantile spasms (IS) were diagnosed; 13 subjects were affected by different types of generalized seizures, associated with complex partial seizures (CPS) in three. In the other 14 patients partial seizures, either simple (SPS) or complex, were present. A localized abnormality was demonstrated in one patient with IS and in three patients with generalized seizures. Of the group of 14 subjects with CPS, MRI and CT were normal in 7, but SPET or PET indicated focal hypoperfusion or hypometabolism concordant with the localization of the EEG abnormalities. In 5 of the other 7 patients anatomical and functional imaging and EEG findings were concordant for a localized abnormality. It can be concluded that functional imaging combined with scalp EEGs appears to be superior to the use of only CT and MRI for selecting children with epilepsy in whom a surgical approach can be considered, in particular when CPS resistant to therapy are present.
Insights
Functional imaging combined with EEG is superior for identifying pediatric drug-resistant epilepsy (DRE) patients eligible for neurosurgery. This approach aids in selecting candidates, especially those with complex partial seizures (CPS).
Area of Science:
- Neuroscience
- Medical Imaging
- Pediatric Neurology
Background:
- Drug-resistant epilepsy (DRE) in children presents significant challenges for treatment.
- Identifying suitable candidates for neurosurgical intervention is crucial for improving outcomes.
- Conventional imaging like MRI and CT may not always reveal localized abnormalities in DRE.
Observation:
- A study evaluated 30 pediatric patients with DRE using MRI, SPET, PET, and EEG.
- Seizure types included infantile spasms (IS), generalized seizures, and complex partial seizures (CPS).
- Functional imaging (SPET/PET) was compared with anatomical imaging (MRI/CT) and EEG findings.
Findings:
- Functional imaging (SPET/PET) combined with EEG identified localized abnormalities in DRE patients where MRI/CT were normal.
- This combination was particularly effective in cases of complex partial seizures (CPS) resistant to therapy.
- Concordance between functional imaging and EEG improved the localization of epileptogenic zones.
Implications:
- Functional imaging integrated with EEG offers a superior method for selecting pediatric epilepsy patients for neurosurgery.
- This approach enhances the precision of identifying surgical candidates, potentially leading to better seizure control.
- The findings support the expanded use of advanced neuroimaging techniques in pediatric epilepsy management.