Evaluation of technetium-99m-ECD in childhood epilepsy.

UNLABELLED: In childhood epilepsy, it is difficult, but of critical importance, to determine whether surgical intervention might be beneficial for an individual patient. Because both established procedures-MRI and electroencephalography (EEG)-have limitations, interictal and ictal regional cerebral blood flow (rCBF) SPECT has proven to be a valuable adjunctive method in the presurgical evaluation of children. METHODS: We evaluated the usefulness of the new rCBF tracer 99mTc-ECD in 14 children with focal epilepsy (mean age 9.7 yr). Eleven interictal and 8 ictal studies were performed. Results were correlated with ictal and interictal surface EEG, MRI and histological findings and the postsurgical outcome. RESULTS: On the basis of the presurgical evaluation, nine patients underwent surgery. MRI studies demonstrated pathological features with possible relation to epilepsy in 50%. Overall, interictal 99mTc-ECD SPECT showed areas of hypoperfusion in 80% of patients. Ictal rCBF SPECT was informative in all patients, including one who showed bifrontal hyperperfusion in accordance with EEG results. CONCLUSION: Technetium-99m-ECD has proven to be of value for interictal and ictal rCBF SPECT in childhood epilepsy. No side effects during or after tracer administration were noticed. Ictal and interictal rCBF SPECT showed good correlation with MRI and EEG results in patients in whom correlation with the postoperative situation was possible and presented additional significant information in those patients with normal MRI and uninterpretable EEG results. No false lateralizations occurred. In children with focal epilepsy, interictal rCBF SPECT may accelerate the application of long-term electrocorticography (ECoG) in patients with normal MRI results. Ictal rCBF SPECT may also help to avoid ECoG, if a focal hyperperfusion correlates with a focal MRI abnormality, and the surface EEG gives no contradictory information.

[Epilepsy in the very old]. / Epilepsien im höheren Lebensalter.

Epilepsy ist the third most common neurological disease of the elderly. In the elderly the incidence is higher than in childhood and adolescence. Cerebrovascular diseases are in 50% of the cases the most common cause for a seizure beyond the age of sixty. The importance of neoplasias is often overestimated. The risk for a renewed seizure after a first seizure is higher in the senium than in youth. Furthermore, the incidence of seizure-related injuries is increased in the elderly and therefore, anticonvulsive therapy must be started early with guaranteed compliance. With regard to therapy, the altered pharmacokinetics in senium must be considered. The drug of first choice is carbamazepine. If a monotherapy with carbamazepine, phenytoin or valproate does not control the seizures a combination with one of the new antiepileptic drugs must be initiated. Due to their pharmacokinetic characteristics, the new drugs-such as vigabatrin, gabapentin and lamotrigine-are specially suitable in the therapy of elderly patients. In case of undesirable side effects, monotherapy with one of the new anti-convulsants ought to be considered.