Ictal SPECT is useful in localizing the epileptogenic zone in infants with cortical dysplasia.
OBJECTIVE
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).


CONCLUSIONS
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.
Department of Pediatric Neurology, Charles University, 2nd Faculty of Medicine, University Hospital Motol, Prague, Czech Republic.
Martin
M
Kudr
Department of Pediatric Neurology, Charles University, 2nd Faculty of Medicine, University Hospital Motol, Prague, Czech Republic.
Pavel
P
Krsek
Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida.
Bruno
B
Maton
Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida.
Stephen
S
Malone
Department of Pediatric Neurology, Charles University, 2nd Faculty of Medicine, University Hospital Motol, Prague, Czech Republic.
Alena
A
Jahodova
Department of Pediatric Neurology, Charles University, 2nd Faculty of Medicine, University Hospital Motol, Prague, Czech Republic.
Vladimir
V
Komarek
Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida.
Prasanna
P
Jayakar
Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA.
Michael
M
Duchowny
D000069279:Drug Resistant Epilepsy / Q000000981:diagnostic imaging* / Q000601:surgery; D004828:Epilepsies, Partial / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007223:Infant; D054220:Malformations of Cortical Development / Q000150:complications*; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon / Q000592:standards*; D016896:Treatment Outcome
epilepsy surgery; focal cortical dysplasia; ictal SPECT; infant