Utility of single-photon emission computed tomography (SPECT) in presurgical evaluation of children: A single-center experience

Outcomes of resective surgery in pediatric patients with drug-resistant epilepsy: A single-center study from the Eastern Mediterranean Region

OBJECTIVE

Epilepsy surgery is widely accepted as an effective therapeutic option for carefully selected patients with drug-resistant epilepsy (DRE). There is limited data on the outcome of epilepsy surgery, especially in pediatric patients from the Eastern Mediterranean region. Hence, we performed a retrospective study examining the outcomes of resective surgery in 53 pediatric patients with focal DRE.

METHODS

Patients with focal DRE who had undergone epilepsy surgery were included in the present study. All patients underwent a comprehensive presurgical evaluation. Postoperative seizure outcomes were classified using the Engel Epilepsy Surgery Outcome Scale.

RESULTS

After surgery, 33 patients (62.2%) were Class I according to the Engel classification of surgical outcomes; eight patients (15.0%) were Class II, 11 (20.7%) were Class III, and one (1.8%) was Class IV. The relationships of presurgical, surgical, and postsurgical clinical variables to seizure outcomes were compared. Older age at seizure onset, older age at the time of surgery, the presence of focal to bilateral tonic-clonic seizures, seizure duration over 2 minutes, unsuccessful treatment with three or fewer antiseizure medications, lesions confined to one lobe (as demonstrated via magnetic resonance imaging [MRI]), surgical site in the temporal lobe, and histopathology including developmental tumors were significantly linked to an Engel Class I outcome. A univariate analysis of excellent surgical outcomes showed that lateralized semiology, localized interictal and ictal electroencephalogram (EEG) discharges, lateralized single-photon emission computed tomography and positron emission tomography findings, and temporal lobe resections were significantly related to excellent seizure outcomes.

SIGNIFICANCE

The results of our study are encouraging and similar to those found in other centers around the world. Epilepsy surgery remains an underutilized treatment for children with DRE and should be offered early.

Application of Three-Dimensional Pseudocontinuous Arterial Spin Labeling Perfusion Imaging in the Brains of Children With Autism

Objective

To explore the application of three-dimensional pseudocontinuous arterial spin labeling (3D-PCASL) perfusion imaging in the brains of children with autism and to understand the characteristics of cerebral blood perfusion in children with autism.

Methods

A total of 320 children with autism (160 men and 160 women) aged between 2 and 18 years and 320 age- and sex-matched healthy children participated in the study. All children were scanned by 3.0 T magnetic resonance axial T1 fluid-attenuated inversion recovery (FLAIR), T2 FLAIR, 3D-T1, and 3D-PCASL sequences. After postprocessing, cerebral blood flow (CBF) values in each brain region of children with autism and healthy children at the same age were compared and analyzed. Furthermore, CBF characteristics in each brain region of autistic children at various ages were determined.

Results

The CBF values of the frontal lobe, hippocampus, temporal lobe, and caudate nucleus of children with autism are lower than those of healthy children (P < 0.05). Additionally, as the ages of children with autism increase, the number of brain regions with decreased CBF values gradually increases. A receiver operating characteristic (ROC) analysis results show that the CBF values of the frontal lobe, hippocampus, temporal lobe, and caudate nucleus can distinguish children with autism [area under the ROC curve (AUC) > 0.05, P < 0.05].

Conclusion

The 3D-PCASL shows lower brain CBF values in children with autism.

Clinical Trial Registration

www.ClinicalTrials.gov, identifier: ChiCTR2000034356.

The accuracy of quantitative EEG biomarker algorithms depends upon seizure onset dynamics

OBJECTIVE

To compare the performance of different ictal quantitative biomarkers of the seizure onset zone (SOZ) across many seizures in a cohort of consecutive patients with a variety of seizure onset patterns.

METHODS

The Epileptogenicity Index (EI, a measure of fast activity) and Slow Polarizing Shift index (SPS, a measure of infraslow activity) were calculated for 212 seizures (22 patients). After stratification by onset pattern, median index values inside and outside the SOZ were compared in aggregate and for each of the onset patterns. Receiver Operating Characteristic (ROC) curves were constructed to compare the performance of each index.

RESULTS

Median values of EI (0.056 vs 0.0087), SPS (0.27 vs 0.19), and CI (0.21 vs 0.12) were significantly higher for contacts inside the SOZ, all p < 0.0001. Analysis of AUC showed variable performance of these indices across seizure types, although AUC for EI and SPS was generally greatest for seizures with fast activity at onset.

CONCLUSIONS

All indices were significantly higher for contacts inside the SOZ; however, the performance of these indices varied depending on the pattern of seizure onset.

SIGNIFICANCE

These findings suggest that future studies of quantitative biomarkers of the SOZ should account for seizure onset pattern.

Distinct changes of brain cortical thickness relate to post-treatment outcomes in children with epilepsy

PURPOSE

In the current study, we examined the potential of neuroanatomic measures to cluster patients into different subgroups and established their clinical relevance to post-treatment outcomes.

METHODS

We included seventy-two children with epilepsy (aged 14-195 months) who were treated with anti-seizure medication alone and 39 healthy participants (aged 36-60 months). High-resolution T1-weighted imaging was performed for all participants, and brain cortical thickness measurements were obtained for 68 cortical regions for each of them. Amongst the patients, data-driven hierarchical cluster analysis was performed using the selected cortical thickness measures as features. The average thickness measures in each of the 68 brain regions were then compared between patient subgroups and healthy controls.

RESULTS

Two distinct patient subgroups were identified but were not related to the clinical types. Patients within subgroup 1 (n = 56) had a significantly higher rate of recurrent seizure than those in subgroup 2 (n = 16) (41.1% vs. 14.3%, p<0.05), while the follow-up time or medication did not differ between them. This finding was further confirmed by a recent follow-up through phone calls. The demographic variables, rate of electroencephalogram abnormalities, or sleep problems did not significantly differ between patient subgroups. Compared with healthy controls, patients in subgroup 1 showed significantly increased cortical thickness in the neocortex, whereas patients in subgroup 2 only showed regional cortical thinning in the right superior temporal gyrus.

CONCLUSION

These findings suggest the potential existence of distinct subgroups of children with epilepsy that were especially relevant to the differential patterns of post-treatment outcomes, with regional cortical thinning in the temporal regions relative to controls predicting lower risk of recurrent seizure.