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From the Departments of Neurology (Drs. Harvey, Hopkins, Berkovic, and Shield) and Nuclear Medicine (Dr. Cook and J. M. Bowe), Royal Children's Hospital, and the Departments of Paediatrics (Dr. Harvey) and Medicine (Dr. Berkovic), University of Melbourne, Melbourne, Australia.
We evaluated ictal 99mtechnetium hexamethyl propylene-amine-oxime single-photon emission computed tomography (SPECT) in 22 children with electroclinical features of frontal lobe epilepsy (FLE). Ictal SPECT demonstrated unilateral frontal hyperperfusion in 20 of 22 children (91%) (one lobar, two frontocentral, six dorsolateral, six frontopolar, three orbitofrontal, one medial frontal, and one insula), concordant with electroclinical lateralization in 19 of 20 (95%). Hyperperfusion was evident in the ipsilateral basal ganglia in 16 of 22 (73%) and the contralateral cerebellum in 14 of 22 children (64%). Interictal SPECT showed unilateral, localized frontal hypoperfusion concordant with electroclinical lateralization in only two of 22 children (9%). Ictal SPECT localization to the frontocentral, medial frontal, or dorsolateral regions was associated with asymmetric tonic posturing, contralateral head/eye deviation, and unilateral clonic jerking (p < 0.01). Ictal SPECT localization to the frontopolar or orbitofrontal regions was associated with vocalization, hyperventilation, truncal flexion, and complex gestural automatisms (p 
0.05). Ictal SPECT has the potential to (1) localize seizures in patients with intractable FLE, and (2) advance understanding of the in vivo anatomico-clinical relationships of frontal lobe seizures.
Address correspondence and reprint requests to Dr. A. Simon Harvey, Department of Neurology, Royal Children's Hospital, Flemington Road, Parkville, 3052, Australia.
Dr. Harvey is a recipient of a Royal Children's Hospital Research Foundation Clinical Research Fellowship and a National Health and Medical Research Council Postgraduate Medical Scholarship.
Received December 4,1992. Accepted for publication in final form March 12, 1993.
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