The role of SPECT in 65 children undergoing video-EEG telemetry for intractable seizures was evaluated at Sydney Children’s Hospital, New South Wales, Australia. Patients with a well-localized epilepsy syndrome and lesion on MRI had the highest concordance with SPECT (86% in the temporal group and 58% in the extratemporal group). In those not localized by MRI, SPECT provided localizing data in more than 50%. Ictal SPECT was of no greater prognostic value before surgery in 23 patients studied with a localized MRI lesion, but it provided additional localization of practical value in patients without lesions. Localization of SPECT to the surgical site was not predictive of surgical outcome. SISCOM confirmed conventional SPECT analysis in 19 of 25 cases, and localized lesions in 4 children in whom SPECT had failed. 
COMMENT. SPECT may be of value in presurgical localization of lesions in children with a normal MRI or nonlocalized epilepsy syndrome.
SPECT and infantile spasms. Focal temporal lobe hypoperfusion is demonstrated on SPECT in infants with spasms, despite normal MRI (Miyazaki M et al. 1994). This series and others using PET are reviewed fully in Progress in Pediatric Neurology III, 1997;pp39-41.