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Jacobs J, Rohr A, Moeller F, Boor R, Kobayashi E, LeVan Meng P, Stephani U, Gotman J, Siniatchkin M. Evaluation of epileptogenic networks in children with tuberous sclerosis complex using EEG-fMRI. Epilepsia 2008; 49:816-25. [DOI: 10.1111/j.1528-1167.2007.01486.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hollo A, Kaminska A, Véra P, Cieuta C, Ville D, Bulteau C, Dulac O, Chiron C. Ictal Perfusion Changes During Occipital Lobe Seizures in Infancy: Report of Two Serial Ictal Observations. Epilepsia 2003. [DOI: 10.1046/j.1528-1157.2001.4220275.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hollo A, Kaminska A, Véra P, Cieuta C, Ville D, Bulteau C, Dulac O, Chiron C. Ictal perfusion changes during occipital lobe seizures in infancy: report of two serial ictal observations. Epilepsia 2001; 42:275-9. [PMID: 11240602 DOI: 10.1046/j.1528-1157.2001.05600.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Serial-ictal single-photon-emission computed tomography (SPECT) examinations are presented in two infants (ages 1 and 2 years), with early ictal and ictal in one, and ictal and late ictal images in the other. Both had pharmacoresistant occipital epilepsy, due to focal cortical dysplasia. In the first case, size of ictal hyperperfusion increased in the course of the seizure from early ictal to ictal state. A concomitant ictal hypoperfusion was observed around the hyperperfused area. In the second patient, there was a dramatic difference between ictal and late ictal images. In the late ictal state, the previous occipital ictal hyperperfusion and extraoccipital ictal hypoperfusion disappeared, together with homolateral posterotemporal and contralateral occipital hyperperfusion, corresponding to seizure propagation. Ictal extratemporal blood-flow changes are therefore highly dynamic, particularly in very young children.
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Affiliation(s)
- A Hollo
- Service Hospitalier Frédéric Joliot, DRM/DSV, CEA, Orsay, France
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Koh S, Jayakar P, Dunoyer C, Whiting SE, Resnick TJ, Alvarez LA, Morrison G, Ragheb J, Prats A, Dean P, Gilman J, Duchowny MS. Epilepsy surgery in children with tuberous sclerosis complex: presurgical evaluation and outcome. Epilepsia 2000; 41:1206-13. [PMID: 10999561 DOI: 10.1111/j.1528-1157.2000.tb00327.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Children with tuberous sclerosis complex (TSC) benefit from excisional surgery if seizures can be localized to a single tuber. We evaluated the role of noninvasive studies to localize the epileptogenic tuber/region (ET/R) and the outcome of focal resection. METHODS We identified 21 children with TSC, ages 3 months to 15 years (mean 4.8 years). All had video-(electroencephalogram) EEG and magnetic resonance imaging (MRI) scans, and 18 also had ictal single photon emission-computed tomography (SPECT) studies. An ET/R was localized in 17 patients. Thirteen patients underwent resection guided by intraoperative electrocorticography (n = 7) or subdural monitoring (n = 6). RESULTS Interictal EEG revealed a principal spike focus (PSF) that corresponded to the ET/R in 14 children. In seven, PSFs occurred in rhythmic runs. PSFs were not observed remote from the ET/R. Focal polymorphic slowing and attenuation occurred in the region of the PSF in 11 patients. Sixteen patients demonstrated an ictal focus corresponding to the ET/R. Ictal SPECT revealed focal hyperperfusion correlating with the ET/R in 10 patients. Although the MRIs in all children revealed multiple tubers, the ET/R corresponded to a large discrete tuber in 8 patients and a calcified tuber in 13 patients. Patchy calcified tubers were also seen elsewhere in six patients. At a mean follow-up of 26 months, 9 of the 13 children who underwent surgery were seizure-free, one had greater than 75% reduction in seizures, two were unchanged, and one was lost to follow-up. New seizures developed in one child from a contralateral tuber. CONCLUSIONS Surgical resection of an ET/R alleviates seizures in most children with TSC and intractable epilepsy. The scalp EEG and MRI help define the ET/R and improve case selection when ictal SPECT is nonlocalizing.
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Affiliation(s)
- S Koh
- Comprehensive Epilepsy Center, Miami Children's Hospital, Florida, USA
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Landrieu P. [What is new in pediatric neurology?]. Arch Pediatr 2000; 7:185-95. [PMID: 10701065 DOI: 10.1016/s0929-693x(00)88090-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Some significant advances in the field of pediatric neurology are reviewed. For many constitutional disorders, concepts and diagnostic procedures have progressed from various genetic techniques or from protein labeling in situ. Many neurodegenerative disorders, some poorly-defined metabolic diseases, and several syndromes associating mental retardation with neurologic or extraneurologic malformations have been characterized. In addition, for many disorders viewed as 'poorly specific' (mental retardation, epilepsy, migraine), familial forms have permitted us to define the first genes involved. In 'acquired' disorders, new data come from clinical trials (antiepileptic, anti-inflammatory drugs) rather than definite conceptual advances. Finally, clinics and biology are no longer the only approaches to brain functions, and clinical neurophysiology could encounter a second wind thanks to the techniques of functional imaging, especially in the fields of developmental neuropsychology.
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Affiliation(s)
- P Landrieu
- Service de neuropédiatrie, centre hospitalier universitaire Paris-Sud-Bicêtre, Le Kremlin-Bicêtre, France
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Bourgeois M, Sainte-Rose C, Lellouch-Tubiana A, Malucci C, Brunelle F, Maixner W, Cinalli G, Pierre-Kahn A, Renier D, Zerah M, Hirsch JF, Goutières F, Aicardi J. Surgery of epilepsy associated with focal lesions in childhood. J Neurosurg 1999; 90:833-42. [PMID: 10223448 DOI: 10.3171/jns.1999.90.5.0833] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Surgery in children with epilepsy is a new, evolving field. The important practical issues have been to define strategies for choosing the most suitable candidates and the type and optimal timing of epilepsy surgery. This study was undertaken to elucidate these points. METHODS To identify the factors that correlated with outcome, the authors analyzed a series of 200 children (aged 1-15 years (mean 8.7 years) who underwent surgery between 1981 and 1996 at the Hôpital Necker-Enfants Malades. In 171 cases (85.5%) the epilepsy was medically refractory and was associated with focal cortical lesions. Surgery consisted of resection of the lesion without specifically attempting to identify and remove the "epileptogenic area. "In the group of children whose seizures were medically refractory, the mean follow-up period was 5.8 years. According to Engel's classification, 71.3% of these children became seizure free (Class 1a,) whereas 82% were in Class I. A multivariate statistical analysis revealed that among all the factors studied, the success of surgery in a patient in whom there was a good clinical/electroencephalogram/imaging correlation depended on the patient's having undergone a minimally traumatic operation, a complete resection of the lesion, and a short preoperative seizure duration. After the surgical control of epilepsy, behavior disorders were more improved (31% of all patients) than cognitive function (25%). The patient age at onset, duration and frequency of seizures, intractability of the disease to therapy, and seizure characteristics were correlated with cognitive, behavioral, and academic performance pre- and postoperatively. Multivariate statistical analysis revealed that cognitive dysfunction correlated highly with the duration of epilepsy prior to surgery, whereas behavioral disorders correlated more with seizure frequency. CONCLUSIONS These data must be taken into account when selecting patients for surgical treatment and when deciding the timing of surgery. Early surgical intervention allows for optimum brain development.
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Affiliation(s)
- M Bourgeois
- Unité de Neurologie Pédiatrique et Service de Neurochirurgie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
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Alfonso I, Papazian O, Litt R, Villalobos R, Acosta JI. Similar brain SPECT findings in subclinical and clinical seizures in two neonates with hemimegalencephaly. Pediatr Neurol 1998; 19:132-4. [PMID: 9744633 DOI: 10.1016/s0887-8994(98)00030-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Brain single-photon emission computed tomography (SPECT) findings during clinical and subclinical seizures were compared in two neonates with hemimegalencephaly. Interictal and ictal brain SPECT were performed in two neonates. The ictal studies were performed during a clinical seizure in one neonate and during a subclinical seizure in another neonate. They revealed similar focal hemispheric hyperperfusion at the electroencephalographic seizure foci in both cases. The similar perfusion patterns imply that clinical and subclinical seizures place similar metabolic demands on the cerebral tissue involved in the generation of electroencephalographic seizures in neonates with cerebral dysgenesis and suggest that clinical and subclinical seizures should be treated similarly in this population.
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Affiliation(s)
- I Alfonso
- Department of Neurology, Miami Children's Hospital, Florida, USA
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Abstract
With the use of 99mTc-D, L,-hexamethylpropylenamine oxime and single photon emission computed tomography, regional cerebral blood flow was measured ictally in 12 mature infants with recurrent seizures and compared with a reference group of nine interictal studies. The study indicates that both clinical and electrical seizures in neonates are associated with a focal cerebral hyperperfusion of the same amount as seen in adults.
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Affiliation(s)
- K Børch
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Denmark
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Kluge A, Kettner B, Zschenderlein R, Sandrock D, Munz DL, Hesse S, Meierkord H. Changes in perfusion pattern using ECD-SPECT indicate frontal lobe and cerebellar involvement in exercise-induced paroxysmal dystonia. Mov Disord 1998; 13:125-34. [PMID: 9452337 DOI: 10.1002/mds.870130124] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The clinical features of exercise-induced paroxysmal dystonia (EPD) are delineated in a pedigree including two affected members (both male) showing an autosomal-dominant inheritance trait. Gait analysis using kinematic electromyography during the motor attacks revealed coactivation of antagonistic calf muscles characteristic of dystonia. In the interval, impaired muscular alternation was observed. To characterize further the pathophysiological basis of the condition, ictal and interictal cerebral perfusion SPECT studies using technetium 99m-ethyl cysteinate dimer (ECD) were performed to establish whether cortical hyperactivity indicative of epilepsy is present during the motor attacks and to identify regional changes in the ictal perfusion pattern that could indicate an anatomic structure relevant to the disease. During the motor attacks, decreased ictal perfusion of the frontal cortex was found in both patients. In contrast, increased cerebellar perfusion was observed. The perfusion of the basal ganglia also decreased. No cortical hyperperfusion indicative of an epileptic nature was seen. Cerebellar hyperactivity in connection with prominent frontal hypoactivity has also been described in both the idiopathic and the symptomatic forms of dystonia. Our findings therefore suggest that EPD represents a paroxysmal movement disorder rather than epilepsy. It is concluded that changes in frontal and in cerebellar function are relevant to the pathophysiology of EPD.
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Affiliation(s)
- A Kluge
- Neurological Clinic, Faculty of Medicine, Humboldt University of Berlin, Germany
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Iannetti P, Spalice A, Atzei G, Boemi S, Trasimeni G. Neuronal migrational disorders in children with epilepsy: MRI, interictal SPECT and EEG comparisons. Brain Dev 1996; 18:269-79. [PMID: 8879645 DOI: 10.1016/0387-7604(96)00026-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Single-photon emission computed tomography (SPECT) is being increasingly used in the investigation of children with epilepsy and may provide insights into congenital malformations. We analyzed the interictal 99Tc-HMPAO-SPECT in a series of seven children with developmental disorders of the neocortex, each of them representing a prototype of cerebral dysgenesis, such as lissencephaly, pachygyria, opercular dysplasia, polymicrogyria, nodular heterotopia and band heterotopia. The patients studied were selected among 22 epileptic children with neuronal migrational disorders (NMDs). Interictal SPECT hypoperfusion was observed in the area homologous to MRI findings in all the examined children. In three patients low perfusion was also present in the opposite hemisphere, probably due to functional involvement or related to an underlying microdysgenesis, not revealed by structural imaging. EEG features were in agreement with low perfusion areas, both anatomically and functionally, in all children. In one patient hypoperfusion area differed from that revealed by MRI and EEG. Ictal SPECT has been considered a useful tool for accurately locating the epileptic focus. Nevertheless, interictal brain perfusion studies, together with proton magnetic resonance spectroscopy, may play an important role in detecting anatomic substrate in developmental disorders of the neocortex.
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Affiliation(s)
- P Iannetti
- Pediatric Department, University La Sapienza, Rome, Italy
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Abstract
Much has been learned from epidemiologic studies about the frequency, causes, natural history, and prognosis of epilepsy and other seizure disorders. This knowledge has resulted in significant changes in the clinical management of individuals who have seizures and epilepsy. Recent changes in the known causal factors and diagnostic technologic advances, among other factors, will affect the epidemiology and prognosis of epilepsy. Continued epidemiologic monitoring of this common neurologic condition is necessary to ensure an accurate understanding of the current forms of the disorder.
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Affiliation(s)
- A T Berg
- School of Allied Health Professions, Northern Illinois University, DeKalb, USA
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Takahashi K, Odano I, Takahashi N. Redistribution on I-123 IMP SPECT in children and adolescents with partial seizures. Clin Nucl Med 1996; 21:227-35. [PMID: 8846569 DOI: 10.1097/00003072-199603000-00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
To evaluate the redistribution phenomenon on delayed I-123 IMP SPECT images of children and adolescents with partial seizures, 25 patients were selected and investigated in the interictal state. Early and delayed SPECT were performed 15-20 minutes and 5 hours, respectively, after I-123 IMP injection. Redistribution patterns were classified into three groups: 1) redistribution (RD) (-) group (n = 5), in which a low-uptake area on the early image persisted or was enlarged on the delayed image, 2) RD (+) group (n = 14), in which a low-uptake area on the early image changed to normal distribution on the delayed image, and 3) marked redistribution (MRD) (+) group (n = 6), In which a low-uptake area on the early image changed to a high uptake area on the delayed image. Among the patients who were followed for at least 12 months after the SPECT scans, the short-term clinical outcome tended to be good in the RD (+) group, intermediate in the MRD (+) group, and poor in the RD (-) group. These results of our preliminary comparative study indicate that the redistribution pattern of I-123 IMP may be related to the clinical aspects in patients with partial seizures and that it may play an important role in predicting their short-term clinical outcome.
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Affiliation(s)
- K Takahashi
- Department of Pediatrics, Niigata University School of Medicine, Japan
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