Metabolic evidence for remote inhibition in epilepsies with continuous spike-waves during sleep

Tiège, Xavier De; Ligot, Noémie; Goldman, Serge; Poznanski, Nathalie; Saint‐Martin, Anne de; Bogaert, Patrick Van

doi:10.1016/j.neuroimage.2007.11.043

Cited by 70 publications

(52 citation statements)

References 25 publications

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“…The extent of cortical glucose hypometabolism can undergo dynamic changes, which is partly related to the frequency of seizures (27). Interestingly, hypermetabolism could be detected in the acute phase of epileptic syndrome, with continuous spikes and waves during slow sleep, but disappeared in the recovery phase (28). Transient hypermetabolism was observed in 9 of 60 patients with SturgeWeber syndrome, which was considered to reflect a period of epileptogenesis (29).…”

Section: Discussionmentioning

confidence: 99%

Glucose Metabolic Profile by Visual Assessment Combined with Statistical Parametric Mapping Analysis in Pediatric Patients with Epilepsy

Zhu

Feng

et al. 2017

J Nucl Med

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PET with 18 F-FDG has been used for presurgical localization of epileptogenic foci; however, in nonsurgical patients, the correlation between cerebral glucose metabolism and clinical severity has not been fully understood. The aim of this study was to evaluate the glucose metabolic profile using 18 F-FDG PET/CT imaging in patients with epilepsy. Methods: One hundred pediatric epilepsy patients who underwent 18 F-FDG PET/CT, MRI, and electroencephalography examinations were included. Fifteen age-matched controls were also included. 18 F-FDG PET images were analyzed by visual assessment combined with statistical parametric mapping (SPM) analysis. The absolute asymmetry index (jAIj) was calculated in patients with regional abnormal glucose metabolism. Results: Visual assessment combined with SPM analysis of 18 F-FDG PET images detected more patients with abnormal glucose metabolism than visual assessment only. The jAIj significantly positively correlated with seizure frequency (P , 0.01) but negatively correlated with the time since last seizure (P , 0.01) in patients with abnormal glucose metabolism. The only significant contributing variable to the jAIj was the time since last seizure, in patients both with hypometabolism (P 5 0.001) and with hypermetabolism (P 5 0.005). For patients with either hypometabolism (P , 0.01) or hypermetabolism (P 5 0.209), higher jAIj values were found in those with drug resistance than with seizure remission. In the post-1-y follow-up PET studies, a significant change of jAIj (%) was found in patients with clinical improvement compared with those with persistence or progression (P , 0.01). Conclusion: 18 F-FDG PET imaging with visual assessment combined with SPM analysis could provide cerebral glucose metabolic profiles in nonsurgical epilepsy patients. jAIj might be used for evaluation of clinical severity and progress in these patients. Patients with a prolonged period of seizure freedom may have more subtle (or no) metabolic abnormalities on PET. The clinical value of PET might be enhanced by timing the scan closer to clinical seizures.

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Section: Discussionmentioning

confidence: 99%

Glucose Metabolic Profile by Visual Assessment Combined with Statistical Parametric Mapping Analysis in Pediatric Patients with Epilepsy

Zhu

Feng

et al. 2017

J Nucl Med

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“…We thus performed a second FDG-PET study to determine the evolution of cerebral metabolism in nine children recovering from CSWS (De Tige et al, 2007b). At the acute phase of CSWS, all children had a metabolic pattern characterized by the association of focal hypermetabolism at the site of the epileptic foci with distinct focal hypometabolic areas.…”

Section: Discussionmentioning

confidence: 99%

Insights into the pathophysiology of psychomotor regression in CSWS syndromes from FDG‐PET and EEG‐fMRI

2009

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SUMMARYEpilepsy syndromes with continuous spikes-andwaves during slow sleep (CSWS) are age-related epileptic encephalopathies characterized by the development of various types of psychomotor regression in close temporal concordance with the appearance of the electroencephalography (EEG) pattern of CSWS. Functional cerebral imaging studies performed in children with CSWS have shown evidence for the existence of increase in metabolism or perfusion at the site of the epileptic focus, associated with decrease in metabolism or perfusion in distant and connected brain areas. Longitudinal [18F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) studies and effective connectivity analyses have suggested the existence of a pathophysiologic link between increases and decreases in metabolism/perfusion that could be explained by the theory of remote inhibition. These findings highlight that the psychomotor regression observed in CSWS syndromes is not only related to the neurophysiologic impairment at the site of the epileptic foci but also to epilepsy-induced neurophysiologic changes in distant connected brain areas. KEY WORDS: Continuous spikes-and-waves during slow sleep, [18F]-Fluorodeoxyglucose, Positron emission tomography, EEG combined fMRI, Remote inhibition, Surrounding inhibition.Epilepsy syndromes with continuous spikes-and-waves during slow sleep (CSWS) are age-related epileptic encephalopathies characterized by the development of various types of psychomotor regression in close temporal concordance with the appearance of the electroencephalography (EEG) pattern of CSWS (Tassinari et al., 2000). This EEG pattern consists of sleep-related activation and diffusion of spike-wave (SW) discharges, usually during more than 85% of non-REM (rapid eye movement) sleep (Tassinari et al., 2000). A minority of CSWS cases have been associated with cortical or thalamic lesions (symptomatic cases), whereas in the other cases, the etiology is unknown (De Tige et al., 2006). In some of the latter cases, the existence of a continuum ranging from asymptomatic carriers of centrotemporal spikes to epilepsies with CSWS is suspected (De Tige et al., 2006).Epilepsy syndromes with CSWS are characterized by an acute phase defined by the emergence of psychomotor deficits, various types of seizures, and CSWS activity at around 3-8 years of age (Holmes & Lenck-Santini, 2006). This acute phase is followed by a recovery phase in which the patient's clinical condition improves together with the remission of the CSWS pattern. Recovery spontaneously occurs at around 15 years of age but it may be prompted by using antiepileptic drugs (AEDs) including corticosteroids (Holmes & Lenck-Santini, 2006). This biphasic evolution suggests that CSWS activity largely contributes to the psychomotor deficits observed in these patients (Holmes & Lenck-Santini, 2006). However, some authors still consider CSWS activity as an epiphenomenon reflecting the underlying brain pathology, rather than the direct cause of the psychomotor regression (Aldenkamp & Arend...

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“…In a significant proportion of childhood epileptic encephalopathies with negative MRI results, 18 F-FDG PET reveals hypometabolic areas-that is, infantile spasms, LennoxGastaut syndrome, or Continuous Spikes and Waves in Slow Sleep syndrome (25,(29)(30)(31). Although epilepsy is commonly referred to as generalized, these hypometabolic areas are focal.…”

Section: F-fdg Pet and Detection Of Hypometabolic Areas In Epileptic mentioning

confidence: 99%

“…Some of them correspond to malformations beyond MRI sensitivity that can be surgically removed, thereby curing epilepsy (32). However, in most instances 18 F-FDG hypofixation areas point out brain areas altered by the epileptic activity: they may either vanish after control of epilepsy (33) or persist in the case of cognitive sequelae (30). They usually extend beyond the epileptic focus and may involve distant areas connected to it (25,30).…”

Section: F-fdg Pet and Detection Of Hypometabolic Areas In Epileptic mentioning

confidence: 99%

“…However, in most instances 18 F-FDG hypofixation areas point out brain areas altered by the epileptic activity: they may either vanish after control of epilepsy (33) or persist in the case of cognitive sequelae (30). They usually extend beyond the epileptic focus and may involve distant areas connected to it (25,30). An EEG-functional MRI approach proved that such widespread hypometabolism resulted from both surrounding and remote inhibition, which might sustain the neuropsychologic impairment (34,35).…”

Section: F-fdg Pet and Detection Of Hypometabolic Areas In Epileptic mentioning

confidence: 99%

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¹⁸F-FDG PET Reveals Frontotemporal Dysfunction in Children with Fever-Induced Refractory Epileptic Encephalopathy

Mazzuca¹,

Jambaqué²,

Hertz-Pannier³

et al. 2010

J Nucl Med

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Fever-induced refractory epileptic encephalopathy in schoolage children (FIRES) is a recently described epileptic entity whose etiology remains unknown. Brain abnormalities shown by MRI are usually limited to mesial-temporal structures and do not account for the catastrophic neuropsychologic findings. Methods: We conducted FIRES studies in 8 patients, aged 6-13 y, using 18 F-FDG PET to disclose eventual neocortical dysfunction. Voxel-based analyses of cerebral glucose metabolism were performed using statistical parametric mapping and an age-matched control group. Results: Group analysis revealed a widespread interictal hypometabolic network including the temporoparietal and orbitofrontal cortices bilaterally. The individual analyses in patients identified hypometabolic areas corresponding to the predominant electroencephalograph foci and neuropsychologic deficits involving language, behavior, and memory. Conclusion: Despite clinical heterogeneity, 18 F-FDG PET reveals a common network dysfunction in patients with sequelae due to fever-induced refractory epileptic encephalopathy.

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Metabolic evidence for remote inhibition in epilepsies with continuous spike-waves during sleep

Cited by 70 publications

References 25 publications

Glucose Metabolic Profile by Visual Assessment Combined with Statistical Parametric Mapping Analysis in Pediatric Patients with Epilepsy

Glucose Metabolic Profile by Visual Assessment Combined with Statistical Parametric Mapping Analysis in Pediatric Patients with Epilepsy

Insights into the pathophysiology of psychomotor regression in CSWS syndromes from FDG‐PET and EEG‐fMRI

¹⁸F-FDG PET Reveals Frontotemporal Dysfunction in Children with Fever-Induced Refractory Epileptic Encephalopathy

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Metabolic evidence for remote inhibition in epilepsies with continuous spike-waves during sleep

Cited by 70 publications

References 25 publications

Glucose Metabolic Profile by Visual Assessment Combined with Statistical Parametric Mapping Analysis in Pediatric Patients with Epilepsy

Glucose Metabolic Profile by Visual Assessment Combined with Statistical Parametric Mapping Analysis in Pediatric Patients with Epilepsy

Insights into the pathophysiology of psychomotor regression in CSWS syndromes from FDG‐PET and EEG‐fMRI

18F-FDG PET Reveals Frontotemporal Dysfunction in Children with Fever-Induced Refractory Epileptic Encephalopathy

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¹⁸F-FDG PET Reveals Frontotemporal Dysfunction in Children with Fever-Induced Refractory Epileptic Encephalopathy