Related Experiment Videos
The practical utility of performing peri-ictal SPECT in the evaluation of children with partial epilepsy
T J O'Brien1, M L Zupanc, B P Mullan
1Department of Neurology, The Mayo Clinic and Mayo Medical School, Rochester, Minnesota 55905, USA.
Insights
Peri-ictal brain single-photon emission computed tomography (SPECT) is effective for localizing partial epilepsy in children. This technique successfully identified seizure origins in most pediatric patients evaluated.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Epilepsy Research
Background:
- Peri-ictal brain single-photon emission computed tomography (SPECT) is established for adult partial epilepsy localization.
- Challenges exist in pediatric application due to ictal injection and imaging acquisition difficulties.
Purpose of the Study:
- To report the Mayo Clinic experience with peri-ictal SPECT in pediatric partial epilepsy.
- To assess the feasibility and localizing value of this technique in children.
Main Methods:
- Peri-ictal SPECT was attempted during 71 admissions in 59 pediatric patients.
- Ictal or post-ictal SPECT injections were performed when feasible.
- Image acquisition and localization analysis were conducted.
Main Results:
- SPECT injection was successful in 72.9% of patients, with successful scans in 97.8% of attempts.
- Of 46 successfully obtained SPECT images, 91.3% were classified as localizing.
- Specific localization was achieved in 92.3% of patients with interpretable scans.
Conclusions:
- Peri-ictal SPECT is feasible in most pediatric partial epilepsy patients with appropriate setup and trained staff.
- The procedure provides valuable specific localizing information for surgical or treatment planning.
- This technique enhances the evaluation of pediatric epilepsy.
Abstract:
Peri-ictal brain single-photon emission computed tomography (SPECT) is increasingly being established as a useful test in localizing partial epilepsy in adults. However, obtaining an ictal injection and acquiring the SPECT images poses a greater challenge in pediatric patients, and few reports have specifically addressed the practical use of this technique in children. The Mayo Clinic experience of peri-ictal SPECT in the evaluation of children with partial epilepsy is reported here. Peri-ictal SPECT was attempted during 71 admissions involving 59 patients (median age 12 years, range 1 year 6 months-17 years). A peri-ictal SPECT injection was performed on 48 (67.6%) of these admissions in 43 (72.9%) patients, and only two patients could not be scanned. Of the 46 peri-ictal images successfully obtained, 30 (65.2%) were from ictal injection and 16 (34.8%) from post-ictal injections. Forty-two (91.3%) of the successfully obtained SPECT images, in 38 patients (92.3%), were classified as localizing (15 temporal, 24 extratemporal). We conclude that, with the appropriate unit setup and well-trained staff, peri-ictal SPECT scans can be obtained in most pediatric partial epilepsy patients. Moreover, the procedure provides specific localizing information in a high proportion of these patients.