Ictal single-photon emission computed tomography (SPECT) was used successfully in the localization of an epileptic focus in two children, ages 9 and 7 years, with intractable epilepsy reported from the University of Alabama at Birmingham Epilepsy Center. CT and initial MRIs were normal, and repeated EEG-video monitoring studies failed to localize the seizures. Resection of the abnormal areas shown by SPECT as hyperperfusion in the frontal lobes revealed a cortical dysplasia. The children had no neurological deficits and remained seizure free 1 year after surgery. 
COMMENT. Ictal SPECT performed exactly at the onset of a clinical seizure precisely localized the primary epileptogenic area in the cortical dysplasia and permitted a discrete resection of the focus without neurologic deficit.