Browse > Article
http://dx.doi.org/10.3345/kjp.2009.52.7.804

Ictal single-photon emission computed tomography with slow dye injection for determining primary epileptic foci in infantile spasms  

Hur, Yun Jung (Department of Pediatrics, Pochon Cha University College of Medicine)
Lee, Joon Soo (Department of Pediatrics, Handicapped Children's Institute, Yonsei University College of Medicine)
Kang, Hoon Chul (Department of Pediatrics, Handicapped Children's Institute, Yonsei University College of Medicine)
Park, Hye Jung (Department of Diagnostic Radiology, Yonsei University College of Medicine)
Yun, Mi Jin (Department of Diagnostic Radiology, Yonsei University College of Medicine)
Kim, Heung Dong (Department of Pediatrics, Handicapped Children's Institute, Yonsei University College of Medicine)
Publication Information
Clinical and Experimental Pediatrics / v.52, no.7, 2009 , pp. 804-810 More about this Journal
Abstract
Purpose : We investigated whether ictal single-photon emission computed tomography (SPECT) with prolonged injection of technetium-99m (99mTc) ethyl cysteinate dimer during repeated spasms can localize the epileptogenic foci in children with infantile spasms. Methods : Fourteen children with infantile spasms (11 boys, 3 girls; mean age, $2.2{\pm}1.3$ years) were examined. When a cluster of spasms was detected during video electroencephalography (EEG) monitoring, $^{99m}Tc$ ethyl cysteinate dimer was slowly and continuously injected for 2 minutes to determine the presence of ictal SPECT. For 7 children, the ictal and interictal SPECT images were visually analyzed, while for the remaining 7 children, the SPECT images were analyzed using the subtraction ictal SPECT coregistered to magnetic resonance imaging (MRI) (SISCOM) technique. Subsequently, we analyzed the association between the ictal SPECT findings and those of other diagnostic modalities such as EEG, MRI, and positron emission tomography (PET). Results : Increase in cerebral blood flow on ictal SPECT involved the epileptogenic foci in 10 cases6 cases analyzed by visual assessment and 4 analyzed by the SISCOM technique. The ictal SPECT and video-EEG findings showed moderate agreement (Kappa=0.57; 95% confidence interval, 0.18-0.96). Conclusion : Ictal SPECT with prolonged injection of a tracer could provide supplementary information to localize the epileptogenic foci in infantile spasms.
Keywords
Infantile spasms; Computed tomography; Single-photon emission;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Commission on Classification and Terminology of the international League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989;30:389-99   DOI   PUBMED   ScienceOn
2 Chugani HT, Shewmon DA, Sankar R, chen BC, Phelps ME. Infantile spasms: II. Lenticular nuclei and brain stem activation on positron emission tomography. Ann Neurol 1992;31: 212-9   DOI   ScienceOn
3 Hwang PA, Otsubo H, Koo BK, Gilday DL, Chuang SH, Jay V, et al. Infantile spasms: Cerebral blood flow abnormalities correlate with EEG, neuroimaging, and pathologic findings. Pediatr Neurol 1996;14:220-5   DOI   ScienceOn
4 Shen W, Lee BI, Park HM, Siddiqui AR, Wellman HH, Worth RM, et al. HIPDM-SPECT brain imaging in the presurgical evaluation of patients with intractable seizures. J Nucl Med 1990;31:1280-4
5 Haginoya K, Kon K, Takayanagi M, Yoshihara Y, Kato R, Tanaka S, et al. Heterogeneity of ictal SPECT findings in nine cases of West syndrome. Epilepsia 1998;39:26-9   DOI   PUBMED   ScienceOn
6 Haginoya K, Munakata M, Yokoyama H, Kato R, Tanaka S, Hirose M, et al. Mechanism of tonic spasms in West syndrome viewed from ictal SPECT findings. Brain Dev 2001;23:496-501   DOI   ScienceOn
7 Newton MR, Austin MC, Chan JG, McKay WJ, Rowe CC, Berkovic SF. Ictal SPECT using technetium-99m-HMPAO: methods for rapid preparation and optimal deployment of tracer during spontaneous seizures. J Nucl Med 1993;34:666- 70
8 Lee BI, Markand ON, Wellman HN, Siddiqui AR, Mock B, Krepshaw J, et al. HIPDM single photon emission computed tomography brain imaging in partial onset secondarily generalized tonic- clonic seizures. Epilepsia 1987;28:305-11   DOI   ScienceOn
9 Avery RA, Zubal IG, Stokking R, Studholme C, Corsi M, Seibyl JP, et al. Decreased cerebral blood flow during seizures with ictal SPECT injections. Epilepsy Res 2000;40:53- 61   DOI   ScienceOn
10 Watanabe K. West syndrome: Etiological and prognostic aspects. Brain Dev 1998;20:1-8   DOI   ScienceOn
11 Asano E, Juhasz C, Shah A, Muzik O, Chugani DC, Shah J, et al. Origin and propagation of epileptic spasms delineated on electrocorticography. Epilepsia 2005;46:1086-97   DOI   ScienceOn
12 Chugani HT, Rintahaka PJ, Shewmon DA. Ictal patterns of cerebral glucose utilization in children with epilepsy. Epilepsia 1994;35:813-22   DOI   ScienceOn
13 Mori K, Toda Y, Hashimoto T, Miyazaki M, Saijo T, Ito H, et al. Patients with West syndrome whose ictal SPECT showed focal cortical hyperperfusion. Brain Dev 2007;29:202- 9   DOI   ScienceOn
14 Dulac O. What is west syndrome? Brain Dev 2001;23:447-52   DOI   ScienceOn
15 Chiron C, Dulac O, Bulteau C, Nuttin C, Depas G, Raynaud C, et al. Study of regional cerebral blood flow in West syndrome. Epilepsia 1993;34:707-15   DOI   ScienceOn
16 Munakata M, Haginoya K, Ishitobi M, Sakamoto O, Sato I, Kitamura T, et al. Dynamic cortical activity during spasms in three patients with West syndrome: A multichannel near- infrared spectroscopic topography study. Epilepsia 2004;45: 1248-57   DOI   ScienceOn
17 Chugani HT, Shields WD, Shewmon DA, Olson DM, Phelps ME, Peacock WJ. Infantile spasms: I. PET identifies focal cortical dysgenesis in cryptogenic cases for surgical treatment. Ann Neurol 1990;27:406-16   DOI   ScienceOn
18 Vallabhajosula S, Zimmerman RE, Picard M, Stritzke P, Mena I, Hellman RS, et al. Technetium-99m ECD: a new brain imaging agent: in vivo kinetics and biodistribution studies in normal human subjects. J Nucl Med 1989;30:599- 604
19 Haginoya K, Munakata M, Kato R, Yokoyama H, Ishizuka M, Iinuma K. Ictal cerebral haemodynamics of childhood epilepsy measured with near-infrared spectrophotometry. Brain 2002;125:1960-71   DOI   ScienceOn