Evolution of lobar abnormalities of cerebral glucose metabolism in 41 children with drug-resistant epilepsy
| Autor: | Harry T. Chugani, Ajay Kumar, Tuhina Govil-Dalela, Michael E. Behen, Csaba Juhász |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Blood Glucose
Male 0301 basic medicine Drug Resistant Epilepsy Pediatrics medicine.medical_specialty Adolescent Developmental Disabilities Cerebral glucose metabolism Article 03 medical and health sciences Epilepsy 0302 clinical medicine Fluorodeoxyglucose F18 medicine Humans Epilepsy surgery Child Dominance Cerebral Retrospective Studies Seizure frequency medicine.diagnostic_test business.industry Brain Infant Electroencephalography medicine.disease Magnetic Resonance Imaging 030104 developmental biology Neurology Positron emission tomography Child Preschool Positron-Emission Tomography Disease Progression Anticonvulsants Female Neurology (clinical) Energy Metabolism business Large group Neurocognitive 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Epilepsia. 59:1307-1315 |
| ISSN: | 0013-9580 |
| DOI: | 10.1111/epi.14404 |
| Popis: | Objective We analyzed long-term changes of lobar glucose metabolic abnormalities in relation to clinical seizure variables and development in a large group of children with medically refractory epilepsy. Methods Forty-one children (25 males) with drug-resistant epilepsy had a baseline positron emission tomography (PET) scan at a median age of 4.7 years; the scans were repeated after a median of 4.3 years. Children with progressive neurological disorders or space-occupying lesion-related epilepsy and those who had undergone epilepsy surgery were excluded. The number of affected lobes on 2-deoxy-2(18 F)-fluoro-D-glucose-PET at baseline and follow-up was correlated with epilepsy variables and developmental outcome. Results On the initial PET scan, 24 children had unilateral and 13 had bilateral glucose hypometabolism, whereas 4 children had normal scans. On the follow-up scan, 63% of the children showed an interval expansion of the hypometabolic region, and this progression was associated with persistent seizures. In contrast, 27% showed less extensive glucose hypometabolism at follow-up; most of these subjects manifested a major interval decrease in seizure frequency. Delayed development was observed in 21 children (51%) at baseline and 28 (68%) at follow-up. The extent of glucose hypometabolism at baseline correlated with developmental levels at the time of both baseline (r = .31, P = .05) and follow-up scans (r = .27, P = .09). Significance In this PET study of unoperated children with focal epilepsy, the lobar pattern of glucose hypometabolism changed over time in 90% of the cases. The results support the notion of an expansion of metabolic dysfunction in children with persistent frequent seizures and its association with developmental delay, and support that optimized medical treatment to control seizures may contribute to better neurocognitive outcome if no surgery can be offered. |
| Databáze: | OpenAIRE |
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