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Photosensitive epilepsy studied by functional magnetic resonance imaging and magnetic resonance spectroscopy
K H Chiappa1, R A Hill, F Huang-Hellinger
1Neurology Department, Massachuetts General Hospital, Boston 02214, USA. chiappa@helix.mgh.harvard.edu
Purpose:
To study metabolic and hemodynamic correlates of photic stimulation-triggered discharges.
Methods:
Simultaneous EEG, functional MRI (tMRI) and magnetic resonance spectroscopy (MRS) were performed in nine patients with photosensitive epilepsy and in 12 normal subjects.
Results:
Prominent visual cortex activation was seen in all normal subjects and patients, and no tMRI-registered hemodynamic abnormalities were correlated with the brief photoparoxysmal spike-wave activity evoked in the photosensitive patients. However, irrespective of the presence of a spike-wave response to the photic stimulation, the photosensitive patients showed four findings not seen in the normal subjects: (a) slightly, but significantly, elevated lactate levels in the occipital cortex in the resting state; (b) an increased area of visual cortical activation with photic stimulation; (c) simultaneous with the occipital cortex stimulus-induced increased fMRI signal, there were noncontiguous areas of signal attenuation most prominent in perirolandic regions; and (d) a marked decrement (undershoot) of fMRI signal intensity immediately after the photic stimulation in the occipital cortex and in the region of the posterior cingulate gyrus.
Conclusions:
These findings suggest abnormal interictal metabolism and increased vascular reactivity in the photosensitive patients.