Ictal perfusion changes during occipital lobe seizures in infancy: Report of two serial ictal observations

Serial-ictal single-photon-emission computed tomography (SPECT) examination s are presented in two infants (ages 1 and 2 years), with early ictal and i ctal in one, and ictal and late ictal images in the other. Both had pharmac oresistant occipital epilepsy, due to focal cortical dysplasia. In the firs t case, size of ictal hyperperfusion increased in the course of the seizure from early ictal to ictal state. A concomitant ictal hypoperfusion was obs erved around the hyperperfused area. In the second patient, there was a dra matic difference between ictal and late ictal images. In the late ictal sta te, the previous occipital ictal hyperperfusion and extraoccipital ictal hy poperfusion disappeared, together with homolateral posterotemporal and cont ralateral occipital hyperperfusion, corresponding to seizure propagation. I ctal extratemporal blood-flow changes are therefore highly dynamic, particu larly in very young children.