Electroencephalography features of primary epileptogenic regions in surgically treated MRI-negative infantile spasms.

Abstract:

OBJECTIVE:To evaluate the surgical outcome for intractable, MRI-negative infantile spasms (IS), and to identify diagnostic targets in the focal epileptogenic area by methods other than MRI. METHODS:We retrospectively studied 9 patients who had had surgery for intractable IS, and whose lesions did not appear on MRI. We analyzed video/electroencephalography (EEG), single photon emission computed tomography (SPECT) and positron emission tomography (PET) findings and their surgical outcomes. In 7 patients who were seizure free after surgery, we analyzed the EEG parameters for characteristics expected in the primary epileptogenic region. RESULTS:All patients underwent resective surgery including frontal lobectomy and multilobar resection. Seven patients showed an Engel class I outcome, and 2 patients showed a class III outcome. Interictal SPECT results showed 66.7% concordance for the hemisphere affected (lateralization), and 55.6% for lesion location (localization). Ictal SPECT showed 71.4% concordance for lateralization and localization. PET showed 66.7% concordance for lateralization, and 55.6% for localization. EEG parameters, including localized paroxysmal fast activities, spindle-shaped fast activities, repetitive or rhythmic sharp/spike wave discharges, and subclinical seizures showed highly localized specificity, and may serve to identify the epileptogenic lesion. CONCLUSION:Surgical treatment of MRI-negative IS should be justified using a combination of diagnostic methods.

journal_name

Pediatr Neurosurg

journal_title

Pediatric neurosurgery

authors

Hur YJ,Lee JS,Kim DS,Hwang T,Kim HD

doi

10.1159/000321925

subject

Has Abstract

pub_date

2010-01-01 00:00:00

pages

182-7

issue

3

eissn

1016-2291

issn

1423-0305

pii

000321925

journal_volume

46

pub_type

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