Haginoya Kazuhiro, Uematsu Mitsugu, Munakata Mitsutoshi, Kakisaka Yosuke, Kikuchi Atsuo, Nakayama Tojo, Hino-Fukuyo Naomi, Tsuburaya Rie, Kitamura Taro, Sato-Shirai Ikuko, Abe Yu, Matsumoto Yoko, Wakusawa Keisuke, Kobayashi Tomoko, Ishitobi Mamiko, Togashi Noriko, Iwasaki Masaki, Nakasato Nobukazu, Iinuma Kazuie
Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan; Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Sendai 982-0241, Japan.
Brain Dev. 2013 Nov;35(10):887-93. doi: 10.1016/j.braindev.2013.08.011. Epub 2013 Sep 15.
The recent findings on subtraction ictal SPECT and ictal near-infrared spectroscopic topography in patients with West syndrome were summarized and its availability for presurgical evaluation was discussed. The subtraction ictal SPECT study in patients with West syndrome demonstrated the cortical epileptic region and subcortical involvement, which may consist of epilepsy networks related to the spasms. Moreover, subtraction ictal SPECT may have predictive power for short-term seizure outcome. Patients with a symmetric hyperperfusion pattern are predicted to have a better seizure outcome, whereas patients with asymmetric hyperperfusion pattern may develop poor seizure control. Importantly, asymmetric MRI findings had no predictive power for seizure outcome. Multichannel near-infrared spectroscopic topography applied to the patients with West syndrome detected an increase in regional cerebral blood volume in multiple areas which were activated either simultaneously or sequentially during spasms. Topographic changes in cerebral blood volume were closely correlated with spasm phenotype, suggesting that the cortex is involved in the generation of spasms. In conclusion, subtraction ictal SPECT may be considered as a useful tool for presurgical evaluation of patients with West syndrome and investigation of the pathophysiology of spasms. The ictal near-infrared spectroscopic topography should be more investigated to see if this is useful tool for presurgical evaluation.
总结了近期关于韦斯特综合征患者发作期SPECT减影和发作期近红外光谱地形图的研究结果，并讨论了其在术前评估中的可用性。韦斯特综合征患者的发作期SPECT减影研究显示了皮质癫痫区域和皮质下受累情况，这可能由与痉挛相关的癫痫网络组成。此外，发作期SPECT减影可能对短期癫痫发作结果具有预测能力。预计对称高灌注模式的患者癫痫发作结果较好，而不对称高灌注模式的患者癫痫控制可能较差。重要的是，不对称的MRI表现对癫痫发作结果没有预测能力。应用于韦斯特综合征患者的多通道近红外光谱地形图检测到多个区域的局部脑血容量增加，这些区域在痉挛期间同时或相继被激活。脑血容量的地形变化与痉挛表型密切相关，表明皮质参与了痉挛的产生。总之，发作期SPECT减影可被视为韦斯特综合征患者术前评估和痉挛病理生理学研究的有用工具。应进一步研究发作期近红外光谱地形图，以确定其是否为术前评估的有用工具。
