FRONTAL-LOBE EPILEPSY - CLINICAL SEIZURE CHARACTERISTICS AND LOCALIZATION WITH ICTAL (99M)TC-HMPAO SPECT

We evaluated ictal technetium-99m hexamethyl propylene-amine-oxime sin gle-photon emission computed tomography (SPECT) in 22 children with el ectroclinical features of frontal lobe epilepsy (FLE). Ictal SPECT dem onstrated unilateral frontal hyperperfusion in 20 of 22 children (91%) (one lobar, two frontocentral, six dorsolateral, six frontopolar, thr ee orbitofrontal, one medial frontal, and one insula), concordant with electroclinical lateralization in 19 of 20 (95%). Hyperperfusion was evident in the ipsilateral basal ganglia in 16 of 22 (73%) and the con tralateral cerebellum in 14 of 22 children (64%). Interictal SPECT sho wed unilateral, localized frontal hypoperfusion concordant with electr oclinical lateralization in only two of 22 children (9%). Ictal SPECT localization to the frontocentral, medial frontal, or dorsolateral reg ions was associated with asymmetric tonic posturing, contralateral hea d/eye deviation, and unilateral clonic jerking (p < 0.01). Ictal SPECT localization to the frontopolar or orbitofrontal regions was associat ed with vocalization, hyperventilation, truncal flexion, and complex g estural automatisms (p greater-than-or-equal-to 0.05). Ictal SPECT has the potential to (1) localize seizures in patients with intractable F LE, and (2) advance understanding of the in vivo anatomico-clinical re lationships of frontal lobe seizures.