Comparative Utility of Technetium-99m Hexamethylpropylenamine Oxime Single Photon Emission Computed Tomography (SPECT) With Anatomic Neuroimaging and Electroencephalography (EEG) in Childhood Intractable Epilepsy

Author:

Kalra Veena1,Gulati Sheffali1,Singh Rana Kamer1,Sekhar Bal Chandra2,Bhatia Manvir3

Affiliation:

1. Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

2. Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

3. Department of Neurology, All India Institute of Medical Sciences, New Delhi, India

Abstract

Intractable epilepsies pose a therapeutic challenge. Precise localization of the epileptic focus is imperative before planning surgical intervention. Functional imaging is an important component of presurgical work-up. Positron emission tomography is unavailable in developing countries; hence, the need to evaluate the available imaging modality, single photon emission computed tomography (SPECT), was felt. We investigated 61 children with intractable epilepsy, identified by predefined criteria, by performing electroencephalography (EEG), magnetic resonance imaging (MRI), computed tomography (CT), and ictal and interictal SPECT. The localizing value of ictal and interictal SPECT imaging for epileptic foci was correlated with clinical, electrophysiologic, and anatomic neuroimaging data. An ictal SPECT was obtained in 9, and interictal SPECT was performed in all (61). Ictal SPECT was localizing in 8 of 9 (88.8%). Interictal SPECT was localizing in a significantly higher proportion of patients (47.54%) than either the scalp EEG (16.39%) ( P = .0003) or CT scan (21.56%) ( P = .0046). Our data demonstrated that interictal and ictal SPECT identified more focal changes in children with intractable epilepsy than interictal EEG, CT, and probably MRI. The definitive proof of the SPECT-based findings being epileptogenic foci awaits correlation with intraoperative monitoring and postoperative follow-up. ( J Child Neurol 2001;16:257-263).

Publisher

SAGE Publications

Subject

Clinical Neurology,Pediatrics, Perinatology, and Child Health

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