The localizing value of ictal SPECT in children with tuberous sclerosis complex and refractory partial epilepsy

Susan Koh, Prasanna Jayakar, Trevor Resnick, Luis Alvarez, Richard E. Liit, Michael Duchowny

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Although multiple cortical tubers are a hallmark of tuberous sclerosis complex (TSC), seizures often originate from a single tuber, making excisional surgery a therapeutic option for intractable patients. To assess the role of ictal single photon emission computed tomography (SPECT) in defining the epileptogenic tuber, we reviewed videoelectroencephalography (V/EEG) data, magnetic resonance imaging (MRI) and SPECT scans of 15 patients (aged 3 months to 15 years, mean 5.1) with medically resistant partial seizures and TSC. SPECT scans were performed using Tc-99m-hexamethylpropyleneamine oxime (HMPAO) injected within 30 seconds of electrographic seizure onset and were graded on a scale from 1 to 5 (1 weakly perfused, 5 strongly perfused). The scalp EEG revealed localized seizure origin in ten patients; five had concordant hyperperfused SPECT regions consisting of comma-shaped areas surrounding hypoperfused areas in the candidate tuber. Strongly hyperperfused regions (grade 3-5) were noted in two patients whose ictal EEG patterns were characterized by sustained, rhythmic fast activity or spiking. The other five patients had nonlocalizing or poorly sustained ictal EEG patterns; one patient in this group had focal hyperperfusion. Invasive EEG recordings in two patients revealed propagated EEG patterns that correlated with the ictal SPECT findings. These findings indicate a strong correlation between ictal SPECT and ictal scalp EEG, especially when there are sustained rhythmic fast ictal EEG patterns.

Original languageEnglish
Pages (from-to)41-46
Number of pages6
JournalEpileptic Disorders
Volume1
Issue number1
StatePublished - Dec 1 1999

Fingerprint

Complex Partial Epilepsy
Tuberous Sclerosis
Single-Photon Emission-Computed Tomography
Electroencephalography
Stroke
Seizures
Scalp
Technetium Tc 99m Exametazime
Magnetic Resonance Imaging

Keywords

  • Electroencephalography
  • Epilepsy surgery
  • Single photon emission computed tomography (SPECT)
  • Subdural recording
  • Tuberous sclerosis complex

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Koh, S., Jayakar, P., Resnick, T., Alvarez, L., Liit, R. E., & Duchowny, M. (1999). The localizing value of ictal SPECT in children with tuberous sclerosis complex and refractory partial epilepsy. Epileptic Disorders, 1(1), 41-46.

The localizing value of ictal SPECT in children with tuberous sclerosis complex and refractory partial epilepsy. / Koh, Susan; Jayakar, Prasanna; Resnick, Trevor; Alvarez, Luis; Liit, Richard E.; Duchowny, Michael.

In: Epileptic Disorders, Vol. 1, No. 1, 01.12.1999, p. 41-46.

Research output: Contribution to journalArticle

Koh, S, Jayakar, P, Resnick, T, Alvarez, L, Liit, RE & Duchowny, M 1999, 'The localizing value of ictal SPECT in children with tuberous sclerosis complex and refractory partial epilepsy', Epileptic Disorders, vol. 1, no. 1, pp. 41-46.
Koh S, Jayakar P, Resnick T, Alvarez L, Liit RE, Duchowny M. The localizing value of ictal SPECT in children with tuberous sclerosis complex and refractory partial epilepsy. Epileptic Disorders. 1999 Dec 1;1(1):41-46.
Koh, Susan ; Jayakar, Prasanna ; Resnick, Trevor ; Alvarez, Luis ; Liit, Richard E. ; Duchowny, Michael. / The localizing value of ictal SPECT in children with tuberous sclerosis complex and refractory partial epilepsy. In: Epileptic Disorders. 1999 ; Vol. 1, No. 1. pp. 41-46.
@article{f1d9b6b678e64839a3a4127d42e1cde8,
title = "The localizing value of ictal SPECT in children with tuberous sclerosis complex and refractory partial epilepsy",
abstract = "Although multiple cortical tubers are a hallmark of tuberous sclerosis complex (TSC), seizures often originate from a single tuber, making excisional surgery a therapeutic option for intractable patients. To assess the role of ictal single photon emission computed tomography (SPECT) in defining the epileptogenic tuber, we reviewed videoelectroencephalography (V/EEG) data, magnetic resonance imaging (MRI) and SPECT scans of 15 patients (aged 3 months to 15 years, mean 5.1) with medically resistant partial seizures and TSC. SPECT scans were performed using Tc-99m-hexamethylpropyleneamine oxime (HMPAO) injected within 30 seconds of electrographic seizure onset and were graded on a scale from 1 to 5 (1 weakly perfused, 5 strongly perfused). The scalp EEG revealed localized seizure origin in ten patients; five had concordant hyperperfused SPECT regions consisting of comma-shaped areas surrounding hypoperfused areas in the candidate tuber. Strongly hyperperfused regions (grade 3-5) were noted in two patients whose ictal EEG patterns were characterized by sustained, rhythmic fast activity or spiking. The other five patients had nonlocalizing or poorly sustained ictal EEG patterns; one patient in this group had focal hyperperfusion. Invasive EEG recordings in two patients revealed propagated EEG patterns that correlated with the ictal SPECT findings. These findings indicate a strong correlation between ictal SPECT and ictal scalp EEG, especially when there are sustained rhythmic fast ictal EEG patterns.",
keywords = "Electroencephalography, Epilepsy surgery, Single photon emission computed tomography (SPECT), Subdural recording, Tuberous sclerosis complex",
author = "Susan Koh and Prasanna Jayakar and Trevor Resnick and Luis Alvarez and Liit, {Richard E.} and Michael Duchowny",
year = "1999",
month = "12",
day = "1",
language = "English",
volume = "1",
pages = "41--46",
journal = "Epileptic Disorders",
issn = "1294-9361",
publisher = "Springer Paris",
number = "1",

}

TY - JOUR

T1 - The localizing value of ictal SPECT in children with tuberous sclerosis complex and refractory partial epilepsy

AU - Koh, Susan

AU - Jayakar, Prasanna

AU - Resnick, Trevor

AU - Alvarez, Luis

AU - Liit, Richard E.

AU - Duchowny, Michael

PY - 1999/12/1

Y1 - 1999/12/1

N2 - Although multiple cortical tubers are a hallmark of tuberous sclerosis complex (TSC), seizures often originate from a single tuber, making excisional surgery a therapeutic option for intractable patients. To assess the role of ictal single photon emission computed tomography (SPECT) in defining the epileptogenic tuber, we reviewed videoelectroencephalography (V/EEG) data, magnetic resonance imaging (MRI) and SPECT scans of 15 patients (aged 3 months to 15 years, mean 5.1) with medically resistant partial seizures and TSC. SPECT scans were performed using Tc-99m-hexamethylpropyleneamine oxime (HMPAO) injected within 30 seconds of electrographic seizure onset and were graded on a scale from 1 to 5 (1 weakly perfused, 5 strongly perfused). The scalp EEG revealed localized seizure origin in ten patients; five had concordant hyperperfused SPECT regions consisting of comma-shaped areas surrounding hypoperfused areas in the candidate tuber. Strongly hyperperfused regions (grade 3-5) were noted in two patients whose ictal EEG patterns were characterized by sustained, rhythmic fast activity or spiking. The other five patients had nonlocalizing or poorly sustained ictal EEG patterns; one patient in this group had focal hyperperfusion. Invasive EEG recordings in two patients revealed propagated EEG patterns that correlated with the ictal SPECT findings. These findings indicate a strong correlation between ictal SPECT and ictal scalp EEG, especially when there are sustained rhythmic fast ictal EEG patterns.

AB - Although multiple cortical tubers are a hallmark of tuberous sclerosis complex (TSC), seizures often originate from a single tuber, making excisional surgery a therapeutic option for intractable patients. To assess the role of ictal single photon emission computed tomography (SPECT) in defining the epileptogenic tuber, we reviewed videoelectroencephalography (V/EEG) data, magnetic resonance imaging (MRI) and SPECT scans of 15 patients (aged 3 months to 15 years, mean 5.1) with medically resistant partial seizures and TSC. SPECT scans were performed using Tc-99m-hexamethylpropyleneamine oxime (HMPAO) injected within 30 seconds of electrographic seizure onset and were graded on a scale from 1 to 5 (1 weakly perfused, 5 strongly perfused). The scalp EEG revealed localized seizure origin in ten patients; five had concordant hyperperfused SPECT regions consisting of comma-shaped areas surrounding hypoperfused areas in the candidate tuber. Strongly hyperperfused regions (grade 3-5) were noted in two patients whose ictal EEG patterns were characterized by sustained, rhythmic fast activity or spiking. The other five patients had nonlocalizing or poorly sustained ictal EEG patterns; one patient in this group had focal hyperperfusion. Invasive EEG recordings in two patients revealed propagated EEG patterns that correlated with the ictal SPECT findings. These findings indicate a strong correlation between ictal SPECT and ictal scalp EEG, especially when there are sustained rhythmic fast ictal EEG patterns.

KW - Electroencephalography

KW - Epilepsy surgery

KW - Single photon emission computed tomography (SPECT)

KW - Subdural recording

KW - Tuberous sclerosis complex

UR - http://www.scopus.com/inward/record.url?scp=0033085855&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033085855&partnerID=8YFLogxK

M3 - Article

C2 - 10937131

AN - SCOPUS:0033085855

VL - 1

SP - 41

EP - 46

JO - Epileptic Disorders

JF - Epileptic Disorders

SN - 1294-9361

IS - 1

ER -