Utility of diagnostic examinations of brain circulation and metabolism in the management of server epilepsies in infancy and young childhood

Abstract

In epileptic encephalopathy, epileptic activity itself may contribute to severe cognitive and behavioral impairments, and it is a case in severe epilepsies in infancy and early childhood. Epilepsies caused by cortical dysplasia are intractable and hence surgical treatment is recommended for them during early childhood when brain functional plasticity is still expected. MRI is generally difficult to interpret because of poor contrast in infancy. Therefore positron emission tomography (PET) and single photon emission computed tomography (SPECT) are useful to identify seizure focus, and SISCOM (Subtraction Ictal SPECT CO-registered to MRI) is particularly important. Eight patients with severe epilepsies underwent a hemispherectomy during infancy and early childhood at the Epilepsy Center of Okayama University Hospital. In two patients, MRI showed uncertain abnormalities, and SISCOM and PET disclosed pathological cortical regions, demonstrating the validity of functional neuroimaging techniques related to brain circulation and metabolism in the evaluation of very young candidate patients for epilepsy surgery.