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 a common childhood epilepsy.
• Altered thalamocortical connectivity is known in SeLECTS, but direct evidence of abnormal thalamic function is lacking.

Purpose of the Study:

• To investigate differences in thalamic blood flow between children with SeLECTS and controls.
• To examine the influence of spike distribution and antiseizure medications (ASMs) on thalamic perfusion.

Main Methods:

• Retrospective cohort study using arterial spin labeling MRI to quantify cerebral blood flow (CBF) in the thalamus.
• Comparison of 44 children with SeLECTS and 35 age/sex-matched controls.
• Analysis of clinical variables including ASM use and spike distribution.

Main Results:

• Children with SeLECTS exhibited elevated thalamic blood flow compared to controls.
• Unilateral spikes were associated with higher CBF, particularly contralateral to the affected thalamus.
• Oxcarbazepine use correlated with the highest CBF, while levetiracetam use showed CBF similar to controls; unmedicated children had intermediate elevations.

Conclusions:

• Elevated thalamic blood flow appears intrinsic to SeLECTS pathophysiology.
• Different ASMs exert distinct effects on thalamic perfusion, potentially explaining differential clinical efficacy.
• Findings offer a neurobiological basis for selecting ASMs in childhood epilepsy.