Objective and Methods:
In order to assess the reliability of ictal SPECT in the preoperative evaluation, 9 children aged from 3 months to 10 years and having partial epilepsy or infantile spasms, underwent ictal SPECT with video-EEG and interictal SPECT plus 3D-MRI two days later. ^(99m)Tc-ECD was injected at a mean 15 seconds after seizure onset. Ictal and interictal images were superimposed, normalized, and substraction images superimposed on MRI.
Results:
Seven partial seizures and 2 epileptic spasms (ES) were recorded on EEG. Hyperperfused foci concordant with EEG were found in only 2 cases by visual inspection of ictal SPECT but in 6 cases using ictal-to-interictal-substraction (2 temporal, 2 parietal, 2 central). Additional hyperperfused foci were found in 4 of them (2 central, 2 parieto-temporo-occipital). Two patients underwent electrocorticography using subdural strips. The hyperperfused foci corresponded to the onset and the propagation of seizures. Cortical hyperperfusion was not detectable in the 3 patients having seizures lasting less than 10 seconds; the 2 patients with ES exhibited hyperperfusion only in subcortical structures.
Conclusion:
Ictal SPECT is a useful technique for localizing seizure discharges and preparing deep investigations in surgical childhood epilepsies particularly when using ictal-to-interictal-substraction images.
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(Spon by: Jean-Pierre Relier)
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Cieuta-Walti, C., Kaminska, A., Chiron, C. et al. Ictal and interictal substraction ECD-SPECT in refractory childhood epilepsy.† 1717. Pediatr Res 41 (Suppl 4), 289 (1997). https://doi.org/10.1203/00006450-199704001-01736
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DOI: https://doi.org/10.1203/00006450-199704001-01736