Comparative utility of technetium-99m hexamethylpropylenamine oxime singlephoton emission computed tomography (SPECT) with anatomic neuroimaging andelectroencephalography (EEG) in childhood intractable epilepsy

Intractable epilepsies pose a therapeutic challenge. Precise localization o f the epileptic focus is imperative before planning surgical intervention. Functional imaging is an important component of presurgical work-up. Positr on emission tomography is unavailable in developing countries; hence, the n eed to evaluate the available imaging modality, single photon emission comp uted tomography (SPELT), was felt. We investigated 61 children with intract able epilepsy, identified by predefined criteria, by performing electroence phalography (EEG), magnetic resonance imaging (MRI), computed tomography (C T), and ictal and interictal SPELT. The localizing value of ictal and inter ictal SPELT imaging for epileptic foci was correlated with clinical, electr ophysiologic, and anatomic neuroimaging data. An ictal SPELT was obtained i n 9, and interictal SPELT was performed in all (61). Ictal SPELT was locali zing in 8 of 9 (88.8%). Interictal SPELT was localizing in a significantly higher proportion of patients (47.54%) than either the scalp EEG (16.39%) ( P =.0003) or CT scan (21.56% (P =.0046). Our data demonstrated that interic tal and ictal SPELT identified more focal changes in children with intracta ble epilepsy than interictal EEG, CT, and probably MRI. The definitive proo f of the SPELT based findings being epileptogenic foci awaits correlation w ith intraoperative monitoring and postoperative follow-up.