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Ictal and interictal SPECT in a newborn infant with intractable seizure
E Koç1, A Serdaroğlu, O Kapucu
1Department of Neonatology, Faculty of Medicine, Gazi University, Ankara, Turkey.
Insights
Diagnosing neonatal seizures is challenging. Technetium-99m HMPAO SPECT imaging may help localize seizure onset in infants when electroencephalogram and MRI findings are unclear.
Area of Science:
- Neurology
- Pediatrics
- Nuclear Medicine
Background:
- Classifying neonatal seizures by onset type (partial vs. generalized) is difficult using clinical presentation, electroencephalogram (EEG), or other imaging.
- Single-photon emission computed tomography (SPECT) is valuable in adults but underutilized in neonates.
Observation:
- A 12-day-old infant presented with intractable seizures.
- Interictal Tc-99m HMPAO SPECT revealed left temporal hypoperfusion; ictal SPECT showed hyperperfusion in the same region.
- EEG indicated generalized epileptiform activity; CT and MRI scans were normal.
Findings:
- SPECT imaging demonstrated a clear localization of hypoperfusion and hyperperfusion correlating with seizure activity.
- This case highlights SPECT's ability to identify focal brain dysfunction in neonatal seizures.
Implications:
- SPECT may offer crucial diagnostic information for neonatal seizures, especially when EEG is generalized and MRI is unremarkable.
- This technique could improve the localization and management of difficult-to-diagnose neonatal seizures.
Abstract:
Neonatal seizures can be difficult to classify according to partial vs generalized onset based on clinical appearance, electroencephalogram (EEG) or other adjunctive imaging techniques. Single-photon emission computed tomography (SPECT) has proven to be useful in adults; however, its use is limited in the paediatric age group, particularly in neonates. A case of a 12-d-old infant with intractable seizures is reported, on whom an interictal Tc-99m HMPAO SPECT showed an area of hypoperfusion in the left temporal cortex, whereas the ictal SPECT revealed prominent hyperperfusion in the same area. The EEG of the infant demonstrated generalized epileptiform activity, while computed tomography and magnetic resonance (MR) imaging findings were normal. This case indicates that the use of SPECT may provide valuable data in evaluation of neonatal seizures, particularly with poorly localized EEG changes and normal MRI scans.