Abstracts

Intractable epilepsy is defined as the persistence of seizures despite adequate trial of antiepileptic drugs with a minimum of two first line drugs either as monotherapy or in combination as appropriate to the epileptic syndrome.
The aim of this work is to assess the role of ictal and interictal SPECT in evaluation of patients with intractable epilepsy [amp] to compare the localizing value of SPECT imaging, for epileptic forci, with that of EEG, MRI and clinical seizune semiology., The study included 39 children (22 males and 17 females) who all had intractable epilepsy. All cases were subjected to full history taking, general and neurological examination, fundus exam, EEG, MRI brain, interictal Single Photon Emission Computed Tomography (SPECT) and ictal SPECT (for 13 cases)., Cases were classified into 2 groups: group A (23 patients with generalized epilepsy) and group B (16 patients with partial epilepsy). Myoclonic epilepsy was the most common subtype of seizures encountered and constituted (38.4%). Epileptic syndromes were described in 9 patients (23%): childhood absence (2 cases), Dravet syndrome (2), myoclonic astatic (1), Lennox-Gastairt (1) and West syndrome (3) Neurocutaneous disorders were 5 cases; storage Weber S. (2), tuberous sclerosis (2) and NFI (1). It was found that in group A, the EEG was sensitive in detecting abnormalities in 78.2%, MRI in 39.1%, intercital SPECT in 56.5% While in group B, EEG was diagnostic in 75%, MRI in 81.2% and interictal SPECT in 87.5%. Ictal SPECT (13 cases) was localizing in 69.2%, interictal SPECT in 38.5%, MRI in 30.7% and EEG in 23.1%. Ictal SPECT was diagnostic and localizing in 4 of 8 cases (50%) in whom MRI was normal., Ictal SPECT was the most sensitive modality in detecting abnormalities in 76.9% compared to 69.2%, 38.5% and 46.2 with EEG, MRI and interical SPECT respectively., (Supported by: This study was carried out in the children hospital, Cairo University, Neuropediatric unit.)