Elevated Thalamic Blood Flow in Self-Limited Epilepsy with Centrotemporal Spikes

Area of Science:

• Neuroscience
• Pediatric Neurology
• Medical Imaging

Background:

• Self-limited epilepsy syndrome with centrotemporal spikes (SeLECTS) is common in children.
• Altered thalamocortical connectivity is known in SeLECTS.
• Thalamic function in SeLECTS remains poorly understood.

Purpose of the Study:

• To investigate thalamic blood flow differences in children with SeLECTS versus controls.
• To examine the impact of spike distribution on thalamic perfusion.
• To assess the effects of antiseizure medications (ASMs) on thalamic blood flow.

Main Methods:

• Retrospective cohort study of children with SeLECTS (n=44) and controls (n=35).
• Arterial spin labeling MRI used to quantify thalamic blood flow (cerebral blood flow - CBF).
• Clinical data on ASM use and spike distribution extracted from medical records.

Main Results:

• Children with SeLECTS showed significantly elevated thalamic blood flow compared to controls.
• Unilateral spikes were associated with higher CBF, especially contralateral to the spike focus.
• Oxcarbazepine was linked to the highest CBF, levetiracetam to CBF similar to controls, and unmedicated children had intermediate elevations.

Conclusions:

• Elevated thalamic blood flow appears intrinsic to SeLECTS pathophysiology.
• Different ASMs exert distinct neurobiological effects on thalamic perfusion.
• Findings suggest a neurobiological basis for selecting ASMs in pediatric epilepsy.