The Usefulness of Subtraction SPECT Co-Registed to MRI in Evaluation of Efficacy of Multiple Subpial Transection in Landau-Kleffner Syndrome.
Abstract number :
2.222
Submission category :
Year :
2001
Submission ID :
2743
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
K.H. Lee, MD, Neurology, Medical College of Georgia, Augusta, GA; Y.D. Park, MD, Neurology, Medical College of Georgia, Augusta, GA; M.R. Lee, MD, PhD, Neurosurgery, Medical College of Georgia, Augusta, GA
RATIONALE: Landau-Kleffner syndrome (LKS) is a rare childhood disorder characterized by acquired aphasia with seizures and characteristic EEG abnormality - continuous spike and wave during sleep (CSWS). Multiple subpial transection (MST) has been tried in selected LKS patients with mixed outcome. In previous studies, the evaluation of efficacy of MST was primarily measured by clinical and EEG outcome without comparing the actual extent of areas affected by MST and the extent of electrographic seizure focus by intracranial EEG monitoring.
METHODS: Two patients (3 and 6 y.o. male) with LKS underwent video-EEG monitoring, 99m Tc-ECD SPECT(radioisotope injected during CSWS confirmed by EEG), and subsequent intracranial EEG monitoring before MST. Postoperatively, patients underwent another SPECT at 6 month when scalp EEG confirmed disappearance of epileptiform discharges. Subtraction SPECT (normalized preop SPECT - normalized postop SPECT) was co-registered to patients[ssquote] own volumetric MRI using commercialized image analysis software package (Analyze 2.5 PC. Mayo BIR, MN).
RESULTS: Both patients showed hyperperfusion of perisylvian area on the preoparative SPECT when radioisotope was injected during CSWS confirmed by EEG. Invasive monitoring with subdural grids and/or depth electrodes successfully localized the electrographic seizure foci in both patients. MST was applied to the epileptogenic area. Scalp EEG at 6 months postop follow-up showed disapperance of epileptiform discharges. Topographic distribution of hyperperfuison by subtraction SPECT (co-registered to MRI) matched the localization of preoprative electrographic focus in both patients.
CONCLUSIONS: Our preliminary results suggest that subtraction SPECT (co-registered to MRI) may be useful in evaluating the effectiveness of MST in LKS. Long term prospective study may be needed to confirm our findings.