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NEUROLOGY 2004;63:853-857
© 2004 American Academy of Neurology

Regional cerebral glucose metabolism in epilepsies with continuous spikes and waves during sleep

X. De Tiège, MD, S. Goldman, MD, S. Laureys, MD, D. Verheulpen, MD, C. Chiron, MD, C. Wetzburger, MD, P. Paquier, PhD, D. Chaigne, MD, N. Poznanski, MS, I. Jambaqué, MS, E. Hirsch, MD, O. Dulac, MD and P. Van Bogaert, MD

From the PET/Biomedical Cyclotron Unit (Drs. De Tiège, Goldman, and Laureys) and Departments of Pediatric Neurology (Drs. De Tiège, Verheulpen, Wetzburger, and Van Bogaert, N. Poznanski) and Neuropsychology (Dr. Paquier), Hôpital Erasme, Université Libre de Bruxelles, Brussels, and Cyclotron Research Centre and Department of Neurology (Dr. Laureys), University of Liège, Belgium; Department of Pediatric Neurology (Drs. Chiron and Dulac, I. Jambaqué), Hôpital Saint Vincent de Paul, Paris, and Department of Pediatric Neurology (Dr. Chaigne), Clinique Sainte Odile, and Department of Neurology (Dr. Hirsch), CHU Strasbourg, France.

Address correspondence and reprint requests to Dr. X. De Tiège, PET/Biomedical Cyclotron Unit, ULB-Hôpital Erasme, 808 route de Lennik, 1070 Brussels, Belgium; e-mail: xdetiege{at}ulb.ac.be

Background: Epileptic syndromes with continuous spikes and waves during sleep (CSWS) represent a wide spectrum of epileptic conditions associated with cognitive dysfunctions that have the EEG pattern of CSWS as a common feature. Reported are the results of voxel-based analyses of brain glucose metabolism performed in a group of 18 children with CSWS.

Methods: Voxel-based analyses of cerebral glucose metabolism were performed using statistical parametric mapping (SPM). First, each patient was compared with a control group and the influence of age, epileptic activity, and corticosteroid treatment on metabolic abnormalities was studied. Also, disease-related changes in the contribution of a brain area to the level of metabolic activity in another brain area were investigated using pathophysiologic interactions in groups of patients compared with the control group.

Results: Individual SPM analyses identified three metabolic patterns: association of hypermetabolic and hypometabolic areas, hypometabolic areas only, and normal pattern. Age and intensity of awake interictal spiking did not significantly differ in patients showing focal hypermetabolism compared with the other ones. Treatment with corticosteroids was associated with absence of focal hypermetabolism. In the group of patients with hypermetabolic areas, analyses of pathophysiologic interactions showed disease-related altered functional connectivity between the parietal and frontal cortices.

Conclusions: Cerebral metabolic patterns are heterogeneous among patients with CSWS. This metabolic heterogeneity could be related to the use of corticosteroid treatment before PET. The parietofrontal altered connectivity observed in patients with hypermetabolism is interpreted as a phenomenon of remote inhibition of the frontal lobes induced by highly epileptogenic and hypermetabolic posterior cortex.

Received January 23, 2004. Accepted in final form May 5, 2004.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the September 14 issue to find the title link for this article.




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[Abstract] [PDF]