Usefulness of Ictal SPECT in the Evaluation of Children with Extratemporal Epilepsy Due to Malformations of Cortical Development.
Abstract number :
2.203
Submission category :
Year :
2001
Submission ID :
401
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
A. Gupta, MD, Pediatirc Neurology, Cleveland Clinic Foundation, Cleveland, OH; P. Kotagol, MD, Pediatric Epilepsy, Cleveland Clinic Foundation, Cleveland, OH; S. Raja, MD, Nuclear Medicine, Cleveland Clinic Foundation, Cleveland, OH; E. Wyillie, MD, Pedia
RATIONALE: Extratemporal epilepsy (ETE) due to malformation of cortical development (MCD) is the most common refractory epilepsy in children.Usefulness of ictal SPECT in this group is not known.The study was aimed at determining the usefulness of ictal SPECT in pre-surgical evaluation of children with ETE due to MCD.
METHODS: Inclusion criteria were 1) age [lt] 18 years at surgery, 2)refractory ETE documented by video EEG, 3)pre-surgical evaluation at the institution[ssquote]s epilepsy center (1996-1999), 4) epilepsy resective surgery, 5) histological diagnosis of MCD. Patients with tuberous sclerosis were excluded. Patients[ssquote] clinical and laboratory data were retrospectively reviewed. Ictal SPECT, PET, MRI and EEG were classified as [italic] localized [/italic] when [ssquote]localizing and concordant[ssquote] with the surgical resection site, [italic] nonconcordant [/italic] when [ssquote]localizing but not concordant[ssquote] with the surgical resection, or [italic] nonlocalized [/italic].
RESULTS: In 15 patients, age 1.5-18 years (median age 8 years), epilepsy was classified as frontal in 7, temporo-parietal in 3, lateral temporal in 2, extensive multilobar in 2 and parietal in 1. MRI was localized in 11, PET in 9, ictal SPECT in 8 and surface EEG in 5. In 4 patients with normal MRI, ictal SPECT and PET were localized in 3 each. Follow-up at 6 months was available in 14 patients. 6 of 7 patients (85%) with localized ictal SPECT compared with 3 of 7 (43%) with nonconcordant/non-localized ictal SPECT had no seizures at follow-up. In 4 patients with normal MRI, 3 with localized ictal SPECT were free of seizures compared to 1 with nonconcordant ictal SPECT who continued to have seizures.
CONCLUSIONS: Ictal SPECT is a useful adjunctive test in pre-surgical evaluation of children with refractory ETE due to MCD, especially when EEG suggests focal epilepsy but MRI is normal.