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Mechanism of tonic spasms in West syndrome viewed from ictal SPECT findings.pdf
Brain Development 23 (2001) 496–501
Review article
/locate/braindev
Mechanism of tonic spasms in West syndrome viewed from ictal SPECT ?ndings
Kazuhiro Haginoyaa,*, Mitsutoshi Munakataa, Hiroyuki Yokoyamaa, Rie Katoa, Soichiro Tanakaa, Mieko Hirosea, Mamiko Ishitobia, Kimiya Kona, Yasushi Yoshiharaa,
Masaru Takayanagia, Tetsuro Yamazakib, Kazuie Iinumaa
aDepartment of Pediatrics, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan bDepartment of Radiology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
Received 19 July 2001; received in revised form 30 July 2001; accepted 2 August 2001
Abstract
To clarify the pathophysiology of tonic spasms, 21 patients with West syndrome were analyzed using ictal and interictal single photon emission computed tomography (SPECT). We focused on whether ictal perfusion changes were observed in the focal cortical region. Eight of the patients studied showed de?nite focal cortical ictal hyperperfusion, indicating that there is a unique subset of West syndrome that can be classi?ed as infantile localization-related epilepsy. Of those eight patients, only two showed asymmetric spasms, suggesting that seizure symptomatology in infants gives only limited information on the localization-related nature of epilepsy. Furthermore, the activation of subcortical structures by focal cortical regions might be attributable to the symmetric seizure phenomena. Thirteen patients showed a diffuse pattern in their ictal SPECTs; this probably included patients with diffuse hyperperfusion and those with no changes. The following have yet to be determined: (1) whether West syndrome is divided into subgroups based on the origin of spasms, in that some patients have the origin in the cortical hemisphere and some have the origin in structures other than the cortical hemisphere, such as the brain stem; (2) whether differences in ictal SPECT patterns re?ect a unique nature of tonic spas
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