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 definite focal cortical ictal hyperperfusion,
indicating that there is a unique subset of West syndrome that can be classified 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
reflect a unique nature of tonic spasms in West syndrome, where tonic spasms appear
in clusters and the interval of each spasm is different among each patient.
Keywords
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Article info
Publication history
Accepted:
August 2,
2001
Received in revised form:
July 30,
2001
Received:
July 19,
2001
Identification
Copyright
© 2001 Elsevier Science B.V. Published by Elsevier Inc. All rights reserved.
