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Ictal patterns of cerebral glucose utilization in children with epilepsy
H T Chugani1, P J Rintahaka, D A Shewmon
1Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit 48201.
Insights
This study classified epilepsy seizure propagation patterns in children using positron emission tomography (PET) scans. Three distinct metabolic patterns were identified, aiding in understanding seizure spread and informing potential epilepsy surgery decisions.
Area of Science:
- Neurology
- Neuroimaging
- Pediatric Epilepsy
Background:
- Epilepsy seizure propagation patterns are complex.
- Understanding these patterns is crucial for effective treatment, especially in pediatric cases.
- Positron emission tomography (PET) offers insights into regional cerebral glucose utilization during seizures.
Purpose of the Study:
- To classify seizure propagation patterns in children with epilepsy using ictal PET.
- To identify distinct metabolic patterns associated with seizure spread.
- To explore the clinical relevance of these patterns for epilepsy surgery.
Main Methods:
- Analyzed ictal PET studies of regional cerebral glucose utilization in 18 children with epilepsy (excluding infantile spasms).
- Classified metabolic patterns based on the degree and type of subcortical involvement.
- Correlated PET findings with patient age and specific brain regions involved.
Main Results:
- Identified three major ictal metabolic patterns: Type I (asymmetric striatal/thalamic metabolism), Type II (symmetric striatal/thalamic abnormalities with neocortical/insular involvement), and Type III (cortex-restricted hypermetabolism).
- Observed age-related differences in pattern expression, particularly concerning cerebellar involvement.
- Noted that the classification accommodates previously described ictal PET and SPECT findings.
Conclusions:
- A novel classification of ictal metabolic patterns in pediatric epilepsy was established.
- This classification provides a framework for understanding seizure propagation.
- Further research is warranted to determine the clinical utility of this classification in epilepsy surgery outcomes.
Abstract:
To determine seizure propagation patterns, we analyzed ictal positron emission tomography (PET) studies of regional cerebral glucose utilization in 18 children (11 male and 7 female aged 2 weeks to 16 years) with epilepsy (excluding infantile spasms IS). Three major metabolic patterns were determined based on degree and type of subcortical involvement: Nine children had type I; asymmetric glucose metabolism of striatum and thalamus. Of these, the 7 oldest children showed unilateral cortical hypermetabolism (always including frontal cortex) and crossed cerebellar hypermetabolism. Two infants (aged < 1 year) had a similar ictal PET pattern but no cerebellar asymmetry, presumably owing to immaturity of corticopontocerebellar projections. Five children had type II, symmetric metabolic abnormalities of striatum and thalamus; this pattern was accompanied by hippocampal or insular cortex hypermetabolism, diffuse neocortical hypometabolism, and absence of any cerebellar abnormality. Four children had type III, hypermetabolism restricted to cerebral cortex. This classification can accommodate ictal PET and single photon emission computed tomography (SPECT) patterns described by other investigators. Future studies should be directed at the clinical relevance of this classification, particularly with regard to epilepsy surgery.