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Utility of Ictal SPECT in the Presurgical Evaluation of Rasmussen's Encephalitis

Published online by Cambridge University Press:  02 December 2014

Jorge G. Burneo
Affiliation:
Epilepsy Programme, University of Western Ontario, London, ON, Canada
Margaret Hamilton
Affiliation:
Epilepsy Programme, University of Western Ontario, London, ON, Canada
William Vezina
Affiliation:
Division of Nuclear Medicine, Department of Radiology, University of Western Ontario, London, ON, Canada
Andrew Parrent
Affiliation:
Epilepsy Programme, University of Western Ontario, London, ON, Canada
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Abstract:

Background:

Rasmussen's encephalitis is a progressive disease characterized by severe progressive neurological and cognitive deficits. It is a difficult condition to treat with conventional medical treatment and requires, in most of the cases, surgical intervention.

Methods:

We present the case of a patient with Rasmussen's encephalitis who presented with epilepsia partialis continua, who did not respond to antiepileptic treatment and was evaluated for possible surgical intervention.

Results:

The electroencephalographic studies revealed bihemispheric involvement during seizures, although magnetic resonance imaging (MRI) showed a marked right hemispheric atrophy. Hyperperfusion over the right hemisphere was seen with the performance of ictal single photon emission computed tomography (SPECT), which finally guided a right functional hemispherectomy and subsequent seizure control.

Conclusion:

Ictal SPECT could be a useful tool in the armamentarium of tools used for the localization of the epileptogenic focus in patients with Rasmussen's encephalitis and other localization-related epilepsies.

Résumé

RÉSUMÉ Contexte:

L'encéphalite de Rasmussen est une maladie progressive caractérisée par des déficits neurologiques et cognitifs progressifs sévères. C'est une maladie difficile à traiter médicalement et il faut avoir recours à la chirurgie dans la plupart des cas.

Méthodes:

Nous présentons le cas d'un patient atteint d'encéphalite de Rasmussen qui a consulté pour une épilepsie partielle continue ne répondant pas au traitement antiépileptique. Il a été évalué en vue d'une chirurgie.

Résultats:

Nos premières tentatives d'utilisation du BiPAP dans le SGB avec insuffisance respiratoire neuromusculaire au début se sont soldées par un échec. L'amélioration initiale était importante, cependant une intubation d'urgence s'est avérée nécessaire chez les deux patients, dont un est devenu subitement cyanosé.

Conclusion:

La gammatomographie critique pourrait être un outil supplémentaire pour localiser le foyer épileptogène chez les patients atteints d'encéphalite de Rasmussen ainsi que chez des patients atteints d'autres épilepsies dues à un foyer localisé.

Type
Case Report
Copyright
Copyright © The Canadian Journal of Neurological 2006

References

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