Otsubo H, Hwang P A, Gilday D L, Hoffman H J
Department of Paediatrics, Hospital for Sick Children, Bloorview Epilepsy Research Program, Ontario, Canada.
J Child Neurol. 1995 Sep;10(5):375-81. doi: 10.1177/088307389501000507.
Several neuroimaging techniques that supplement electrophysiologic methods of evaluating pediatric patients with localization-related epilepsies before surgery assess both structural and functional abnormalities. For example, single photon emission computed tomography (SPECT) with technetium-99m-hexamethylpropyleneamine oxime (99mTc-HMPAO) has been used to demonstrate abnormal cerebral perfusion. States of cerebral perfusion during the interictal and immediate postictal periods have been reported to correlate with epileptiform foci identified by electroencephalogram (EEG). Between January 1987 and March 1993, we studied 55 pediatric patients with intractable seizures with prolonged video EEG telemetry in the epilepsy monitoring unit, followed by computed tomography, magnetic resonance imaging, and SPECT, before surgery to determine whether SPECT studies with 99mTc-HMPAO improved the accuracy of locating the epileptic focus. Interictal SPECT was performed on all patients, and immediate postictal SPECT (within 10 minutes after seizure ended) on 17 patients monitored in the epilepsy monitoring unit. In 15 (88%) of the 17, the combination of interictal and postictal SPECT studies yielded results corresponding to the EEG abnormality, a result significantly better than that obtained from interictal studies alone: 21 (55%) of 38 (chi 2 = 5.647, P = .0175). SPECT scans showed localized abnormal perfusion in the ipsilateral temporal lobe in all six patients with mesial temporal sclerosis, but precise results were not obtained in cases of dual pathology and neuronal migration disorders. Depiction of cerebral perfusion by interictal and immediate postictal SPECT studies can lead to greater accuracy in the localization of epileptic foci.
几种神经影像学技术可补充在手术前评估患有局灶性相关性癫痫的儿科患者的电生理方法，这些技术可评估结构和功能异常。例如，使用锝-99m-六甲基丙烯胺肟（99mTc-HMPAO）的单光子发射计算机断层扫描（SPECT）已被用于显示脑灌注异常。据报道，发作间期和发作后即刻的脑灌注状态与脑电图（EEG）确定的癫痫样病灶相关。1987年1月至1993年3月期间，我们在癫痫监测病房对55例患有顽固性癫痫发作的儿科患者进行了长时间视频脑电图遥测研究，随后在手术前进行了计算机断层扫描、磁共振成像和SPECT检查，以确定使用99mTc-HMPAO的SPECT研究是否能提高癫痫病灶定位的准确性。对所有患者进行了发作间期SPECT检查，对癫痫监测病房监测的17例患者进行了发作后即刻SPECT检查（发作结束后10分钟内）。在这17例患者中的15例（88%）中，发作间期和发作后SPECT研究的联合结果与EEG异常相符，这一结果明显优于仅进行发作间期研究的结果：38例中的21例（55%）（χ2 = 5.647，P = 0.0175）。在所有6例患有内侧颞叶硬化的患者中，SPECT扫描显示同侧颞叶有局限性异常灌注，但在双重病理和神经元迁移障碍的病例中未获得精确结果。发作间期和发作后即刻SPECT研究对脑灌注的描绘可提高癫痫病灶定位的准确性。
