Abstracts

Rationale: Localiztion of the epileptogenic zone in childfood intractable epilepsy is considered difficult comparing to that of adult for preoperative evaluation. We assess the utility of subtraction ictal single-photon emission computed tomography (SPECT) coregistered to MRI (SISCOM) for localization of the epileptogenic zone in pediatric epilepsy surgery. Methods: Thirty children (4 month- 9 years, mean 3.6 years) with intractable epilepsy who had undergone epilepsy surgery between 1999 and 2008 were included. We retrospectively analyzed the correlation between surgical outcome and the concordance of SISCOM findings to other functional neuroimagings for preoperative workup. Results: Thirty patients were divided into three groups according to the concordance of functional neuroimagings. Group A(11 patients): SISCOM, 2-[18F]fluoro-2-deoxyglucose- positron emission tomography (FDG-PET), and magnetoencephalography (MEG) findings were concordant. Group B(6 patients) :SISCOM was concordant with another neuroimaging (FDG-PET or MEG). Group C (13 patients): SISCOM was disconcordant with FDG-PET and MEG. In group A, 10 of the 11 patients (91%) underwent resective surgery (focal/lobar resection, multilobar disconnection, hemispherotomy). 9 patients (90%) achieved free from seizures. In group B, 5 of the 6 patients (83%) underwent resective surgery, 3 patients (60%) achieved free from seizures. Resective surgery was performed in 7 of 13 patients (54%) in group C. Seizure free was achieved in 4 patients (57%). Conclusions: SISCOM is useful to localize the epileptogenic zone in pediatric epilepsy surgery. Concordance of SISCOM findings to other functional neuroimaging suggests favorable seizure outcome in resective surgery.