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Related Experiment Videos

Hemimegalencephaly: evaluation with positron emission tomography

P J Rintahaka1, H T Chugani, C Messa

  • 1Department of Neurology, UCLA School of Medicine 90024.

Pediatric Neurology
|January 1, 1993
PubMed
Summary

Positron emission tomographic (PET) studies in children with hemimegalencephaly (HME) revealed cortical hypometabolism in the non-affected hemisphere. This finding is crucial for predicting surgical outcomes in epilepsy patients.

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Area of Science:

  • Neuroscience
  • Medical Imaging
  • Pediatric Neurology

Background:

  • Hemimegalencephaly (HME) is a congenital brain malformation often leading to intractable epilepsy and developmental delays.
  • Surgical hemispherectomy is a treatment option for severe HME, but outcomes vary.
  • The developmental outcome in HME patients post-hemispherectomy may be influenced by the function of the non-affected hemisphere.

Purpose of the Study:

  • To investigate the utility of 2-deoxy-2[18F]fluoro-D-glucose positron emission tomographic (PET) studies in evaluating HME patients with intractable epilepsy.
  • To test the hypothesis that dysfunction in the structurally normal non-HME hemisphere contributes to poor developmental outcomes.
  • To assess the correlation between glucose metabolism in the non-HME hemisphere and surgical prognosis.

Main Methods:

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  • Positron emission tomographic (PET) studies using 2-deoxy-2[18F]fluoro-D-glucose were conducted in 8 children with HME.
  • Visual analysis of cortical glucose metabolism in the non-HME hemisphere was performed and compared to controls.
  • Epilepsy surgery outcomes were correlated with PET findings.

Main Results:

  • Cortical hypometabolism was visually identified in the non-HME hemisphere of 4 out of 8 patients.
  • One patient with a specific metabolic pattern suggesting a cortical lamination defect and bilateral seizure onset was deemed not a surgical candidate.
  • A general correlation was observed between glucose utilization patterns in the less affected hemisphere and patient prognosis.

Conclusions:

  • PET imaging can reveal cortical hypometabolism in the non-HME hemisphere of patients with hemimegalencephaly.
  • Preoperative assessment of the non-HME hemisphere's integrity is recommended for surgical planning.
  • Early hemispherectomy (within the first year of life) may be beneficial for maximizing brain plasticity in HME patients with intractable epilepsy.