Ictal Perfusion Brain SPECT in Pediatric Patients with Intractable Epilepsy: A Multidisciplinary Approach

Objective: Localizing epileptogenic regions of the brain is important in the diagnosis and treatment of pediatric patients with intractable epilepsy. Ictal perfusion brain SPECT can be used to localize these epileptogenic foci. Ictally, a focal perfusion increase is observed in >90% of the patients, but the radiotracer must be given to the child during the seizure. Since it is not practical to have nuclear medicine personnel waiting for the patient to experience a seizure, a multidisciplinary approach was developed that included nuclear medicine, neurology, nursing and radiation safety. Methods: Six nurses were trained in the procedures necessary to safely administer precalibrated doses of tracer to the patient during seizures. Technetium-99m-bicisate was used for the studies because the 6-hr shelf-life provided a reasonable time frame in which to capture the seizures. Patients were transported to nuclear medicine for imaging 1–3 hr after tracer administration. Results: Between June 1994 and July 1995 we obtained ictal SPECT in 30 children. Focal increases in rCBF were detected in more than 90% of these patients. In contrast, interictal SPECT in the same patients revealed regional decreases in cerebral blood flow in only 50% of these studies. Conclusion: Multidisciplinary cooperation and training allowed consistently successful ictal SPECT in epileptic patients. Ictal SPECT is more sensitive for the localization of epileptogenic foci than interictal SPECT.