The localizing value of ictal SPECT in children with tuberous sclerosis complex and refractory partial epilepsy.

Abstract

Although multiple cortical tubers are a hallmark of tuberous sclerosis complex (TSC), seizures often originate from a single tuber, making excisional surgery a therapeutic option for intractable patients. To assess the role of ictal single photon emission computed tomography (SPECT) in defining the epileptogenic tuber, we reviewed videoelectroencephalography (V/EEG) data, magnetic resonance imaging (MRI) and SPECT scans of 15 patients (aged 3 months to 15 years, mean 5.1) with medically resistant partial seizures and TSC. SPECT scans were performed using Tc-99m-hexamethylpropyleneamine oxime (HMPAO) injected within 30 seconds of electrographic seizure onset and were graded on a scale from 1 to 5 (1 weakly perfused, 5 strongly perfused). The scalp EEG revealed localized seizure origin in ten patients; five had concordant hyperperfused SPECT regions consisting of comma-shaped areas surrounding hypoperfused areas in the candidate tuber. Strongly hyperperfused regions (grade 3-5) were noted in two patients whose ictal EEG patterns were characterized by sustained, rhythmic fast activity or spiking. The other five patients had nonlocalizing or poorly sustained ictal EEG patterns; one patient in this group had focal hyperperfusion. Invasive EEG recordings in two patients revealed propagated EEG patterns that correlated with the ictal SPECT findings. These findings indicate a strong correlation between ictal SPECT and ictal scalp EEG, especially when there are sustained rhythmic fast ictal EEG patterns.

• Authors: S Koh, P Jayakar, T Resnick, L Alvarez, R E Liit, M Duchowny
• Journal: Epileptic disorders : international epilepsy journal with videotape (Epileptic Disord) Vol. 1 Issue 1 Pg. 41-6 (Mar 1999) ISSN: 1294-9361 [Print] France
• PMID: 10937131 (Publication Type: Journal Article)

Chemical References

• Technetium Tc 99m Exametazime

Topics

• Adolescent
• Brain Mapping
• Cerebral Cortex (diagnostic imaging, physiopathology, surgery)
• Child
• Child, Preschool
• Electroencephalography
• Epilepsies, Partial (diagnostic imaging, physiopathology, surgery)
• Epilepsy, Complex Partial (diagnostic imaging, physiopathology, surgery)
• Female
• Humans
• Infant
• Male
• Technetium Tc 99m Exametazime
• Tomography, Emission-Computed, Single-Photon
• Tuberous Sclerosis (diagnostic imaging, physiopathology, surgery)
• Video Recording