Ictal Focal Hyperperfusion Demonstrated by Arterial Spin Labeling in Child With Refractory Frontal Lobe Epilepsy: A Case Report

Abstract BackgroundEpilepsy is one of the most common chronic neurological diseases, despite the great variety and prevalence of antiepileptic drug treatments, one-third of epilepsies remain drug-resistant. To our best knowledge, the patient reported in this case report is the first case of children with frontal lobe epilepsy achieving rapid and non-invasive surgical localization by arterial spin labeling (ASL) with EEG.Case presentationA 4-year-old previously healthy girl with repeated panic attacks and generalized tonic-clonic seizures. Levetiracetam, clonazepam, oxcarbazepine, and lacosamide were successively administrated with poor outcome. Seizure control was not obtained from any of these treatments. Using the quantitative analysis system of CBF, the imaging on PLD1025ms presented a mean CBF value of 17.81ml/100g/min for the lesion, 36% of the average value of the entire right hemisphere, thus presenting abnormally significant hypoperfusion. The patient became seizure free after lesionectomy of the frontal lobe by ASL combined with electroencephalogram (EEG) rapid localization. And the histopathological diagnosis was focal cortical dysplasia (FCD) type IIa. And there was no recurrence of the seizure was observed for 6 months after the operation.ConclusionsThe positive outcome suggests that the combined use of ASL with EEG could be a beneficial option for presurgical evaluation of pediatric epilepsy.