Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India.
Department of Paediatric Neurology, Rainbow Children's Hospital, Hyderabad, India.
Neurol India. 2019 Jan-Feb;67(1):169-172. doi: 10.4103/0028-3886.253622.
The role of cerebellum in seizure generation is debatable. Semiology and electroencephalography (EEG) findings are non-specific and sometimes misleading, posing further difficulty in proving the epileptogenicity in pre-surgical workup. We report two cases of cerebellar lesions who presented with hemifacial seizures since the neonatal period and were refractory to antiepileptic drugs (AEDs). Both inter-ictal and ictal EEGs were non-contributory. Magnetic resonance imaging (MRI) showed a lesion in the cerebellum, in proximity to cerebellar peduncle in both the patients. (18) F-fluorodeoxyglucose-positron emission tomography (FDG-PET) and ictal single photon emission computed tomography (SPECT) showed focal hypermetabolism and hyperperfusion respectively, corresponding to the lesion on MRI in both the cases. Intraoperative electrocorticography showed rhythmic spikes confirming the epileptogenic nature of the lesion. Both patients were operated with a favorable surgical outcome. Histopathology was suggestive of a ganglioglioma in one child and a low-grade glioma in the other. Both cases illustrate that FDG-PET and SPECT can act as surrogate markers for invasive recordings to prove the epileptogenicity of cerebellar lesions, especially in resource limited settings.
小脑在癫痫发作中的作用存在争议。症状学和脑电图 (EEG) 发现是非特异性的，有时具有误导性，这进一步增加了在术前评估中证明致痫性的难度。我们报告了两例小脑病变患者，他们从新生儿期开始就出现半面性癫痫发作，且对抗癫痫药物 (AED) 耐药。发作间期和发作期 EEG 均无明显异常。磁共振成像 (MRI) 显示两名患者的小脑均存在病变，靠近小脑脚。（18）氟代脱氧葡萄糖-正电子发射断层扫描 (FDG-PET) 和发作期单光子发射计算机断层扫描 (SPECT) 分别显示局灶性高代谢和高灌注，与 MRI 上的病变相对应。术中皮质脑电图显示节律性棘波，证实了病变的致痫性。两名患者均接受了手术治疗，结果良好。组织病理学提示一例为神经节细胞瘤，另一例为低度胶质瘤。这两个病例都表明，FDG-PET 和 SPECT 可以作为侵袭性记录的替代标志物，以证明小脑病变的致痫性，特别是在资源有限的情况下。
