Seizures in paediatric Chiari type I malformation: the role of single-photon emission computed tomography.
Chiari type I malformation is one of the posterior fossa maldevelopments with which different clinical manifestations have been associated. Seizures have only recently been associated with Chiari type I malformation. This study reports on 4 children with epilepsy (2M, 2F; age range 8-15 y) diagnosed with Chiari type I malformation by brain magnetic resonance imaging (MRI), in whom no cortical structural involvement was observed. In these patients an interictal ethylcysteinate-dimer-single-photon emission computed tomographic (ECD-SPECT) study was performed to define more precisely the relationship between Chiari type I malformation and seizures. In these patients the hypoperfusion area correlated with electroencephalographic (EEG) focal abnormalities. These hypoperfusions may represent the functional aspect of a cerebral microdysgenesis; seizures and EEG epileptic anomalies may also be linked to the complex network connection between cortices and cerebellar hemispheres. A cerebellar hypoperfusion was also detected in two of the four examined patients, indicating a functional or structural involvement.


CONCLUSIONS
Interictal SPECT scans are helpful for the clarification of seizures in patients with Chiari type I malformation.
Iannetti
P
P
Division of Pediatric Neurology La Sapienza University, Roma, Italy. iannetti@uniroma1.it
Spalice
A
A
De Felice Ciccoli
C
C
Bruni
O
O
Festa
A
A
Maini
C L
CL
D000293:Adolescent; D001139:Arnold-Chiari Malformation / Q000150:complications*; D002648:Child; D015331:Cohort Studies; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012640:Seizures / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*