A 15 year old boy had 10–12 partial complex seizures per day inspite of adequate 4 drugs antiepileptic regime. He had a history of repeated high-grade fever in childhood. MRI for epilepsy protocol revealed normal brain scan. What should be the best noninvasive strategy to make a definite diagnosis so that he can be prepared to undergo epilepsy surgery –
If localization of epileptic focus is unrevealed on MRI, Ictal SPECT with HMPAO is the most practical and best method. Addition of video EEG further helps in localization of epileptic foci.
Interictal scalp EEG
Video EEG
Interictal 18F–FDg PET.
Video EEG with Ictal 99m Tc – HMPAO Brain SPECT