SURGERY FOR INTRACTABLE INFANTILE SPASMS - NEUROIMAGING PERSPECTIVES

Twenty-three infants and children underwent cortical resection (n = 15 ) or hemispherectomy (n = 8) for intractable infantile spasms. Infanti le spasms were present at the time of surgery in 17 of the 23 patients ; in six, spasms had evolved to other seizure types during surgical ev aluation. Children with a remote history of infantile spasms were excl uded from this study. Focal or hemispheric lesions were identified by magnetic resonance imaging in seven children; an additional two showed focal atrophy without a discrete lesion. Positron emission tomography (PET) showed lateralized or localized abnormalities of cerebral gluco se utilization in all patients; in 14, PET was the only neuroimaging m odality to identify the epileptogenic cortex. When this occurred, neur opathological examination of resected brain tissue typically showed ma lformative and dysplastic cortical lesions. Focal interictal and/or ic tal electrographic abnormalities were present in all patients, and cor responded well with localization from neuroimaging. None of the patien ts were subjected to chronic invasive electrographic monitoring with i ntracranial electrodes. At follow-up (range 4-67 months; mean 28.3 mon ths), 15 children were seizure-free, three had 90% seizure control, on e had 75% seizure control, and four failed to benefit from surgery wit h respect to seizure frequency.