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Ictal SPECT is useful in localizing the epileptogenic zone in infants with cortical dysplasia
Author(s) -
Kudr Martin,
Krsek Pavel,
Maton Bruno,
Malone Stephen,
Jahodova Alena,
Komarek Vladimir,
Jayakar Prasanna,
Duchowny Michael
Publication year - 2016
Publication title -
epileptic disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.673
H-Index - 53
eISSN - 1950-6945
pISSN - 1294-9361
DOI - 10.1684/epd.2016.0870
Subject(s) - ictal , cortical dysplasia , ictal interictal spect analysis by spm , epilepsy , epilepsy surgery , medicine , electroencephalography , magnetic resonance imaging , dysplasia , cortex (anatomy) , lesion , anesthesia , radiology , surgery , psychology , neuroscience , psychiatry
Aims . To assess the localizing value of ictal SPECT in very young epilepsy surgery candidates when cerebral haemodynamic responses are known to be immature. Methods . We retrospectively studied 13 infants with intractable focal epilepsy caused by focal cortical dysplasia (FCD). Completeness of resection of the (1) ictal SPECT hyperperfusion zone and (2) cerebral cortex with prominent ictal and interictal abnormalities on intracranial EEG (ECoG or long‐term invasive monitoring) and the MRI lesion, when present, were correlated with postoperative seizure outcome. Results . All five patients with complete resection of the ictal SPECT hyperperfusion zone were seizure‐free compared to only one of eight patients with incomplete or no excision of hyperperfusion zones ( p =0.00843). Similar results were noted for the MRI/iEEG‐defined epileptogenic region; five of six patients with complete removal were seizure‐free, whereas only one of seven incompletely resected patients was seizure‐free ( p =0.02914). All four patients who underwent complete resection of both regions were seizure‐free compared to none of the six with incomplete resection ( p =0.01179). Conclusion . Despite age‐related differences in cerebral perfusion, ictal SPECT provides useful localization data in infants with FCD. Complete resection of the hyperperfused regions is a strong predictor of favourable outcome. The added information may alleviate the need for invasive EEG evaluations in some patients.