title: Predictive factors of ictal SPECT findings in paediatric patients with focal cortical dysplasia.
abstract: OBJECTIVE
  To identify variables that influence the extent of ictal single-photon emission computed tomography (SPECT) findings in paediatric patients with focal cortical dysplasia (FCD).
  
  
  METHODS
  We visually evaluated 98 ictal SPECT studies from 67 children treated surgically for intractable epilepsy caused by FCD. SPECT findings were classified as "non-localised", "well-localised", and "extensive" and compared with parameters of injected seizures (seizure type and duration, injection time, and scalp EEG ictal pattern), presence of structural pathology on MRI, type of surgery performed after SPECT study, and histological findings.
  
  
  RESULTS
  A shorter injection time and duration of injected seizure was associated with more localised SPECT hyperperfusion. SPECT findings were not significantly influenced by type of injected seizure. Widespread ictal scalp EEG patterns were associated with extensive SPECT findings. Larger zones of hyperperfusion were more common in patients with lesional MRI and patients undergoing multilobar resections. SPECT studies demonstrating good localisation were more common in patients with mild malformations of cortical development.
  
  
  CONCLUSIONS
  Early ictal SPECT radiotracer injection is crucial for successful localisation of the epileptogenic zone. Seizure duration, type of scalp EEG findings, and presence of structural pathology on MRI may influence the extent of ictal SPECT hyperperfusion, which was associated with certain types of epilepsy surgery as well as histopathological findings.
authors.affiliation: Department of Paediatric Neurology, Charles University, 2nd Faculty of Medicine, University Hospital Motol, Prague, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Kudr
authors.affiliation: Department of Paediatric Neurology, Charles University, 2nd Faculty of Medicine, University Hospital Motol, Prague, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Krsek
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Miami Children's Hospital, Miami, Florida, United States.
authors.forename: Bruno
authors.initials: B
authors.lastname: Maton
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Miami Children's Hospital, Miami, Florida, United States.
authors.forename: Stephen
authors.initials: S
authors.lastname: Malone
authors.affiliation: Department of Paediatric Neurology, Charles University, 2nd Faculty of Medicine, University Hospital Motol, Prague, Czech Republic.
authors.forename: Alena
authors.initials: A
authors.lastname: Jahodova
authors.affiliation: Department of Paediatric Neurology, Charles University, 2nd Faculty of Medicine, University Hospital Motol, Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Jezdik
authors.affiliation: Department of Paediatric Neurology, Charles University, 2nd Faculty of Medicine, University Hospital Motol, Prague, Czech Republic.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Komarek
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Miami Children's Hospital, Miami, Florida, United States.
authors.forename: Ian
authors.initials: I
authors.lastname: Miller
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Miami Children's Hospital, Miami, Florida, United States.
authors.forename: Prasanna
authors.initials: P
authors.lastname: Jayakar
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Miami Children's Hospital, Miami, Florida, United States, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States.
authors.forename: Trevor
authors.initials: T
authors.lastname: Resnick
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Miami Children's Hospital, Miami, Florida, United States, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Duchowny
mesh_terms: D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D011237:Predictive Value of Tests; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
keywords: Ictal SPECT; epilepsy surgery; focal cortical dysplasia