Relationship Between Brain Glucose Metabolism Positron Emission Tomography (PET) and Electroencephalography (EEG) in Children With Continuous Spike-and-Wave Activity During Slow-Wave Sleep

Abstract

We studied the relationship between brain glucose metabolism patterns and objectively measured interictal epileptiform abnormalities in six children with intractable epilepsy and continuous spike-and-wave activity during slow-wave sleep. Five of the six patients showed lateralized positron emission tomographic (PET) findings, with the hemisphere showing a relative increase in glucose metabolism concordant with the presumed origin of the generalized interictal spike activity delineated by quantitative electroencephalographic (EEG) analysis. One of these five patients achieved seizure freedom following cortical resection involving the areas of unilateral multifocal hypermetabolism, and another patient has been approved for cortical resection. The results in the present study add further support to the hypothesis that the generalized spike-waves in most cases of continuous spike-and-wave activity during slow-wave sleep are the result of secondary bilateral synchrony. Resective surgery can be effective in selected patients with uncontrolled seizures associated with continuous spike-and-wave activity during slow-wave sleep provided that there is concordance between focal abnormalities on PET and EEG.

Thalamic abnormalities in children with continuous spike‐wave during slow‐wave sleep: An F‐18‐fluorodeoxyglucose positron emission tomography perspective

“…35 Most quantitative studies of FDG-PET in CSWS have focused on cortical metabolism in CSWS. 31,36 Our group has previously demonstrated regional changes in cerebral metabolism in patients with CSWS using FDG-PET. 36 Focal hypermetabolism has been proposed as a hallmark of acute CSWS, with evolution to cortical hypometabolism in the residual stage of the disease.…”

“…31,36 Our group has previously demonstrated regional changes in cerebral metabolism in patients with CSWS using FDG-PET. 36 Focal hypermetabolism has been proposed as a hallmark of acute CSWS, with evolution to cortical hypometabolism in the residual stage of the disease. 37,38 In the present study, only 9 of 16 patients in the acute phase of CSWS demonstrated cortical hypermetabolism.…”

How to establish causality in epilepsy surgery

“…Yet, PET studies using simultaneous scalp EEG recording reported that very frequent interictal epileptiform discharges, if present, were associated with glucose hyper metabolism in the presumed epileptogenic hemisphere. Cortical resection involving such glucose hypermetabolism was reported to result in a good seizure outcome [10, 39]. A plausible explanation for hypermetabolism on interictal PET is that very frequent interictal spike discharges may transiently increase glucose metabolic demands regionally (e.g.…”

Effect of sleep on interictal spikes and distribution of sleep spindles on electrocorticography in children with focal epilepsy

“…Previous studies also demonstrated that the frequency and spatial field of interictal spike activity were greater during sleep with spindles compared to wakefulness in children with various forms of epilepsies including focal epilepsy, Landau-Kleffner syndrome and continuous spike-waves during slow wave sleep (Nobili et al, 1999;2001;Luat et al, 2005). Previous studies describing the cyclic alternating pattern of sleep indicated that the phase A with K-complex and slow-waves may be an excitatory phase associated with increased frequency of interictal epileptiform discharges while phase B with low-voltage fast waves, including sleep spindles alone, may be an inhibitory phase (Terzano et al, 1991;Terzano et al, 1992;Zucconi et al, 2000;Eisensehr et al, 2001).…”