The localizing value of ictal SPECT in children with tuberous sclerosis complex and refractory partial epilepsy

Epileptic Disord. 1999 Mar;1(1):41-6.


Although multiple cortical tubers are a hallmark of tuberous sclerosis complex (TSC), seizures often originate from a single tuber, making excisional surgery a therapeutic option for intractable patients. To assess the role of ictal single photon emission computed tomography (SPECT) in defining the epileptogenic tuber, we reviewed videoelectroencephalography (V/EEG) data, magnetic resonance imaging (MRI) and SPECT scans of 15 patients (aged 3 months to 15 years, mean 5.1) with medically resistant partial seizures and TSC. SPECT scans were performed using Tc-99m-hexamethylpropyleneamine oxime (HMPAO) injected within 30 seconds of electrographic seizure onset and were graded on a scale from 1 to 5 (1 weakly perfused, 5 strongly perfused). The scalp EEG revealed localized seizure origin in ten patients; five had concordant hyperperfused SPECT regions consisting of comma-shaped areas surrounding hypoperfused areas in the candidate tuber. Strongly hyperperfused regions (grade 3-5) were noted in two patients whose ictal EEG patterns were characterized by sustained, rhythmic fast activity or spiking. The other five patients had nonlocalizing or poorly sustained ictal EEG patterns; one patient in this group had focal hyperperfusion. Invasive EEG recordings in two patients revealed propagated EEG patterns that correlated with the ictal SPECT findings. These findings indicate a strong correlation between ictal SPECT and ictal scalp EEG, especially when there are sustained rhythmic fast ictal EEG patterns.

MeSH terms

  • Adolescent
  • Brain Mapping*
  • Cerebral Cortex / diagnostic imaging
  • Cerebral Cortex / physiopathology
  • Cerebral Cortex / surgery
  • Child
  • Child, Preschool
  • Electroencephalography
  • Epilepsies, Partial / diagnostic imaging*
  • Epilepsies, Partial / physiopathology
  • Epilepsies, Partial / surgery
  • Epilepsy, Complex Partial / diagnostic imaging*
  • Epilepsy, Complex Partial / physiopathology
  • Epilepsy, Complex Partial / surgery
  • Female
  • Humans
  • Infant
  • Male
  • Technetium Tc 99m Exametazime
  • Tomography, Emission-Computed, Single-Photon*
  • Tuberous Sclerosis / diagnostic imaging*
  • Tuberous Sclerosis / physiopathology
  • Tuberous Sclerosis / surgery
  • Video Recording


  • Technetium Tc 99m Exametazime