Utility of subtraction ictal SPECT images in detecting focal leading activity and understanding the pathophysiology of spasms in patients with West syndrome

Yosuke Kakisaka, Kazuhiro Haginoya, Mamiko Ishitobi, Noriko Togashi, Taro Kitamura, Keisuke Wakusawa, Ikuko Sato, Naomi Hino-Fukuyo, Mitsugu Uematsu, Mitsutoshi Munakata, Hiroyuki Yokoyama, Kazuie Iinuma, Tomohiro Kaneta, Shuichi Higano, Shigeru Tsuchiya

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)

Abstract

Purposes: The aims of the study were to evaluate the detectability of focal leading activity in three cases of West syndrome having focal abnormal activity on EEG by comparing subtraction ictal images and raw ictal images, and to interpret the results in 16 cases. Methods: Subtraction images were constructed using iNeurostat (revision 2). Results: In three cases with focal abnormal activity on EEG, subtraction ictal images reflected the EEG findings; in contrast, raw ictal images did not. Diverse degrees of cortical hyperperfusion, ranging from zero to 10 sites, seen in the other 13 cases seemed to reflect spasm pathophysiology and rapid spasm propagation. Subtraction ictal images also allowed the ready detection of hyperperfusion of subcortical structures and of a tight cortico-subcortical relationship in a subset of cases. Conclusions: We showed the superiority of subtraction ictal images in detecting the focal epileptic region and in showing propagation pathways from the cortex to subcortical structures. A subset of spasms in WS may be focal cortical-onset secondarily generalized seizures. We believe that subtraction analysis is valuable in patients with complex WS who have partial seizures and spasms simultaneously along with focal epileptic EEG activity, as they will likely be candidates for epilepsy surgery.

Original languageEnglish
Pages (from-to)177-183
Number of pages7
JournalEpilepsy Research
Volume83
Issue number2-3
DOIs
Publication statusPublished - 2009 Feb

Keywords

  • Epileptic spasms
  • Propagation
  • Subtraction ictal SPECT
  • West syndrome

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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