Klinički značaj interiktalne jednofotonske emisijske kompjuterizirane tomografije mozga u procjeni funkcionalnog oštećenja mozga u djece s parcijalnom epilepsijom Clinical value of interictal photon emision computerized tomography in evaluation of functional brain impairment in children with partial epilepsy

摘要

INTRODUCTION: Clinical studies about the influence of clinical parameters of epilepsy andudcharacteristics of patients on the result of qualitative/semiquantitative interictal SPECT analysis haveudbeen shown inconsistent results. Furthermore, the use of SPECT method in paediatric population hasudbeen evaluated in smaller number of studies and in smaller number of cases than adults. AIM: Theudaim of this study was to investigate clinical importance of interictal 99mTc-HMPAO SPECT method inudevaluation of functional brain damage in children with partial epilepsy and the influence of certainudpatients' characteristics and clinical parameters of epilepsy. RESULTS: Boys with symptomaticudepilepsy have statistically higher number of bilateral and left-sided changes on 99mTc-HMPAOudSPECT, regardless the refractory nature of symptomatic epilepsy, while girls have more normalud99mTc-HMPAO SPECT findings. Average number of ROI with regional hypoperfusion in childrenudwith idiopathic partial epilepsies gradually increases in accordance to decline in pychological testingudand that number is highest in children with border IQ/SMR and with positive Bender test, regardlessudthe refractory nature of epilepsy. In children with well controlled epilepsy and positive Bender testudthere is significantly higher number of altered SPECT findings and left ROI with hypoperfusion,udwhile children with well controlled symptomatic epilepsy and Bender have statistically higherudnumber of ROI with hypoperfusion. There is statistical significance of correlation between theudnumber of ROI with regional hypoperfusion and the age at time of first seizure and duration ofudepilepsy, not considering the refractory nature and aetiology of partial epilepsy. The age at the time ofudfirst seizure, epilepsy duration and/or the age at the time of 99mTc-HMPAO SPECT have predictiveudvalue for number of ROI with regional hypoperfusion on 99mTc-HMPAO SPECT, especially in theudgroup of refractory idiopathic epilepsy. In children with secondary generalisation of seizures, theudmost frequent ROI with regional hypoperfusion are in temporal region and in children withoutudsecondary generalization of seizures the most frequent ROI are in frontal regions. The finding ofud141ud99mTc-HMPAO SPECT changes in children with symptomatic epilepsy is not always in accordanceudwith anatomical changes on brain MRI; it depends on refractory nature of epilepsy and it is reflectionudof functional brain damage. Visual and semiquantitative 99mTc-HMPAO SPECT analysis revealsudstatistically higher number of normal findings than EEG findings and these changes are moreudfrequently situated on only one brain hemisphere. Number of regions with regional hypoperfusion isudstatistically higher in children treated with polytherapy, regardless the aetiology of epilepsy.udCONCLUSION: Interictal 99mTc-HMPAO SPECT method has clinical significance in evaluation ofudfunctional brain damage in children with partial epilepsy. Characteristics of patients (age, sex, resultsudof psychological testing, previous febriles seizures) and clinical parameters of disease (age ast the theudof diagnosis, duration of epilepsiy, intractability, number of antiepileptics in therapy) can influenceudthe intensity and localization of regional brain hypoperfusion regardless the aetiology andudcatastrophic nature of partial epilepsy.