Proton magnetic resonance spectroscopic observations of epilepsia partialis continua in children

Brain metabolite values in children with breath-holding spells

Breath-holding spells are benign, paroxysmal events with apnea and postural tone changes after a crying episode in infants. The objective of this study was to investigate the pathologies in brain metabolite values in the absence of seizure in children with breath-holding spells by using magnetic resonance spectroscopy (MRS). Brain MRS examination was performed on 18 children with breath-holding spells and 13 neurologically normal children who were included as the control group. There was no significant difference in terms of N-acetyl aspartate (NAA), choline (Cho), creatine (Cr), and myoinositol (mI) levels and also in terms of NAA/Cr, Cho/Cr, and mI/Cr ratios between the patients and the control group (all P>0.05). Our study suggested that there is no permanent neuronal damage in patients with breath-holding spells. This result confirms the previous studies, which reported no permanent neuronal damage in patients with breath-holding spells.

Susceptibility of immature and adult brains to seizure effects

The extent that status epilepticus (SE), but also brief seizures, affects neuronal structure and function has been the subject of much clinical and experimental research. There is a reliance on findings from animal research because there have been few prospective clinical studies. This review suggests that the features of seizure-induced injury in the immature brain compared with the adult brain are different and that duration of seizures (SE versus brief), number of seizures, cause of seizures, presence of pre-existing abnormalities, and genetics affect the injury. Increased awareness of age-specific injuries from seizure has promoted research to determine the circumstances under which seizures may produce permanent detrimental effects. Together with recent advances in functional neuroimaging, genomic investigation, and prospective human data, these studies are likely to substantially increase our knowledge of seizure-induced injury, leading to the development of improved algorithms for prevention and treatment of epilepsy.

A longitudinal MRI study in children with Rasmussen syndrome

The aim of this study was to identify the presence of any neuroimaging patterns of Rasmussen syndrome using magnetic resonance imaging (MRI). This was a prospective study evaluating brain MRIs in seven children with neuropathologically proven Rasmussen syndrome. All patients were unresponsive to conventional antiepileptics; five patients subsequently underwent functional hemispherectomy, and two patients underwent cortical resection. Three to eight (mean = 4.7) MRIs per patient were performed, and neuropathologic examination of the brain was available. Serial MRIs were obtained between 12 months before and 9 months after the onset of epilepsia partialis continua. The most common region of initial MRI signal change was the frontocentral region (six patients). Three patterns of neuroimaging abnormalities were observed as follows: (1) normal MRI followed by increased signal intensity with progressive cortical atrophy over time, (2) initial increased focal signal intensity followed by decrease in spatial extent and degree of signal intensity; (3) initially increased signal intensity without further changes on follow-up scans. This observation suggests three possible distinct patterns of MRI changes in patients with Rasmussen syndrome and that the differences in these neuroimaging patterns may reflect inherent differences in the pathogenesis of Rasmussen syndrome.