Interictal hyperemia correlates with epileptogenicity in polymicrogyric cortex
Lauro Wichert-Ana1, Paulo Mazzoncini de Azevedo-Marques, Lucas Ferrari Oliveira
1Department of Neurology, Psychiatry and Clinical Psychology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil. lwichert@rnp.fmrp.usp.br
Objective:
To investigate pathophysiological factors underlying the presence of interictal hyperperfusion within the limits of the polymicrogyric (PMG) cortex in epileptic patients.
Methods:
Retrospective observational study on interictal perfusion by Single Photon Emission Computed Tomography (SPECT) in 16 patients with PMG and its correlations with a number of clinical and neurophysiological variables. Patients underwent video-EEG monitoring, neurological and psychiatric assessments, invasive EEG, and the interictal SPECT coregistered to Magnetic Resonance Imaging (MRI).
Results:
Patients with interictal hyperperfusion within the PMG cortex had a significantly higher spike rate on interictal EEG than patients with normal perfusion. Interictal hyperperfusion was not correlated to sex, age at epilepsy onset, age at evaluation, number of seizures per month, presence of initial precipitating insult (IPI), abnormal neurological examination, EEG findings, ictal semiology, and seizure outcome. The high interictal spike rate did not correlate to a high frequency of seizures per month.
Conclusions:
Our work provides further evidences for an intrinsic epileptogenesis of the PMG cortex during the interictal state, which accounts for the major role of PMG tissue in seizure generation. These results might help to increase our understanding about epileptogenesis related to the PMG cortex, providing new tools for more tailored epilepsy surgery in PMG patients.
Insights
Polymicrogyria (PMG) cortex in epilepsy patients shows interictal hyperperfusion linked to higher EEG spike rates, suggesting intrinsic epileptogenesis. This finding aids understanding of PMG-related seizures and epilepsy surgery.
Area of Science:
- Neuroscience
- Epileptology
- Medical Imaging
Background:
- Polymicrogyria (PMG) is a cortical malformation associated with epilepsy.
- The pathophysiological basis of interictal hyperperfusion in PMG remains unclear.
Purpose of the Study:
- To investigate factors contributing to interictal hyperperfusion within the PMG cortex in epileptic individuals.
- To explore the relationship between interictal hyperperfusion and clinical/neurophysiological variables.
Main Methods:
- Retrospective observational study of 16 epilepsy patients with PMG.
- Utilized Single Photon Emission Computed Tomography (SPECT) for interictal perfusion assessment.
- Correlated SPECT findings with video-EEG, neurological/psychiatric assessments, and invasive EEG, co-registered with MRI.
Main Results:
- Patients with interictal hyperperfusion in the PMG cortex exhibited significantly higher interictal EEG spike rates compared to those with normal perfusion.
- Interictal hyperperfusion did not correlate with demographic factors, seizure frequency, neurological examination, EEG findings, or seizure outcome.
- Elevated interictal spike rates were not associated with increased monthly seizure frequency.
Conclusions:
- The study provides evidence for intrinsic epileptogenesis within the PMG cortex during the interictal state.
- PMG tissue plays a significant role in seizure generation.
- Findings may enhance understanding of PMG-related epileptogenesis and inform tailored epilepsy surgery strategies.
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