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Neuronal migrational disorders in children with epilepsy: MRI, interictal SPECT and EEG comparisons
P Iannetti1, A Spalice, G Atzei
1Pediatric Department, University La Sapienza, Rome, Italy.
Insights
Single-photon emission computed tomography (SPECT) effectively identified brain hypoperfusion in children with epilepsy and neuronal migrational disorders. This imaging technique aids in detecting developmental brain abnormalities not always visible on MRI.
Area of Science:
- Neurology
- Pediatric Epilepsy
- Neuroimaging
Background:
- Epilepsy in children often involves neuronal migrational disorders (NMDs).
- Congenital malformations can underlie NMDs.
- Advanced neuroimaging is crucial for diagnosis.
Purpose of the Study:
- To evaluate the utility of interictal 99Tc-HMPAO-SPECT in children with NMDs.
- To correlate SPECT findings with MRI and EEG in these patients.
- To explore SPECT's role in identifying the anatomic substrate of developmental disorders.
Main Methods:
- Analysis of interictal 99Tc-HMPAO-SPECT scans in seven children with NMDs.
- Comparison of SPECT findings with MRI and EEG data.
- Patients were selected from a cohort of 22 epileptic children with NMDs.
Main Results:
- SPECT revealed hypoperfusion in areas consistent with MRI findings in all subjects.
- Three patients showed contralateral hypoperfusion, suggesting functional involvement or occult microdysgenesis.
- EEG data generally correlated with SPECT and MRI findings.
Conclusions:
- Interictal SPECT is valuable for detecting hypoperfusion in developmental neocortical disorders.
- SPECT can identify abnormalities not evident on structural imaging (MRI).
- SPECT, combined with other techniques, aids in diagnosing the anatomic basis of pediatric epilepsy related to NMDs.
Abstract:
Single-photon emission computed tomography (SPECT) is being increasingly used in the investigation of children with epilepsy and may provide insights into congenital malformations. We analyzed the interictal 99Tc-HMPAO-SPECT in a series of seven children with developmental disorders of the neocortex, each of them representing a prototype of cerebral dysgenesis, such as lissencephaly, pachygyria, opercular dysplasia, polymicrogyria, nodular heterotopia and band heterotopia. The patients studied were selected among 22 epileptic children with neuronal migrational disorders (NMDs). Interictal SPECT hypoperfusion was observed in the area homologous to MRI findings in all the examined children. In three patients low perfusion was also present in the opposite hemisphere, probably due to functional involvement or related to an underlying microdysgenesis, not revealed by structural imaging. EEG features were in agreement with low perfusion areas, both anatomically and functionally, in all children. In one patient hypoperfusion area differed from that revealed by MRI and EEG. Ictal SPECT has been considered a useful tool for accurately locating the epileptic focus. Nevertheless, interictal brain perfusion studies, together with proton magnetic resonance spectroscopy, may play an important role in detecting anatomic substrate in developmental disorders of the neocortex.