In this work, 31P phosphorus NMR (31P NMR) studies of the brain have been conducted in rats acutely and chronically intoxicated with ethanol. In both groups, changes in levels of high-energy phosphates were observed: increase of phosphocreatinine (PCr)/beta AaTP and PCr/inorganic phosphate (Pi) in acute and long-term ethanol exposure, and decrease of Pi/beta ATP after acute ethanol administration. These changes in high-energy phosphates, indicative of a reduction of adenosine triphosphate (ATP) and PCr consumption (PCr+ ADP+ H+ ATP+ Cr; ATP ADP+ Pi), suggest a reduction of cerebral metabolism both in acute and chronic ethanol exposure. In addition, in the group of rats chronically intoxicated with ethanol, there were variations in phosphodiester peak intensities (decrease of phosphomonoester (PME)/phosphodiester (PDE), increase of PDE/beta ATP), suggesting increased breakdown of membrane phospholipids. These changes could provide a metabolic explanation for the development of cerebral atrophy in chronic alcoholism.

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SUMMARY Fourteen children with various seizure disorders were studied using a cerebral blood flow tracer, 123I iodoamphetamine (0.05 mCi/kg), and single photon emission computed tomography (SPECT). In the five patients with radiological lesions, SPECT showed congruent or more extensive abnormalities. Five of the nine children with a normal scan on computed tomography had abnormal SPECT studies consisting of focal hypoperfusion, diffuse hemispheric hypoperfusion, multifocal and bilateral hypoperfusion, or focal hyperperfusion. A focal lesion seen on SPECT has been found in children with tonic-clonic seizures suggesting secondarily generalised seizures. Moreover the pattern seen on SPECT seemed to be related to the clinical status. An extensive impairment found on SPECT was associated with a poor evolution in terms of intellectual performance and seizure frequency. Conversely all children with a normal result on SPECT had less than two seizures per year and normal neurological and intellectual development.The usefulness of studies with positron emission tomography in adult epilepsy is now well established.1' Both cerebral metabolism and cerebral blood flow are significantly increased during focal or generalised seizures while both are depressed in the postictal and interictal state.2 3 The presence of the interictal abnormality is remarkable in view of the fact that neuroradiological techniques usually fail to show any structural lesions in patients who might benefit from surgical treatment.4Unfortunately, facilities for positron emission tomography are not widely available and remain very expensive. New cerebral blood flow tracers which are labelled with conventional y ray emitters have been developed and allow the use of the single photon emission computed tomographic (SPECT) devices present in most nuclear medicine departments. The major determinants of the brain distribution of these tracers are cerebral blood flow and neuronal mass.5 Although this technique is purely semiquantitative, its low cost and convenience make it highly attractive for a widespread clinical use.Studies performed in adults using 123I iodoamphetamine and SPECT have shown similar alterations as previously described in positron emission tomography.6 Childhood epilepsy is a complex disorder, as indicated by the clinical pleiomorphism, the variety of aetiologic factors, and the unpredictable evolutions. There are only a few available data on abnormalities of cerebral metabolism in seizure disorders.7 8 In this report we present our initial experience of cerebral blood flow imaging using 123i iodoamphetamine and SPECT in children with various seizure disorders. Patients and methodsFourteen children aged 2 months to 16 years were investigated after informed consent of the parents and according to a protocol accepted by our local committee for medical ethics. Nine were known and treated epileptics: three had tonic-clonic seizures, two had complex partial seizures, two suffered from Bravais-Jacksonian crisis, one from absences, and one from a Le...

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The outlook for children with cerebral palsy is determined by the severity of motor problems and the presence of associated disabilities, in which early detection remains a medical challenge. The authors studied 13 children (aged 13 months to 12 years) with cerebral palsy by means of single photon emission computed tomography (SPECT) of the brain with technetium-99m hexamethylpropyleneamineoxime (HMPAO). In all children with hemiplegia, SPECT demonstrated hypoperfusion in the hemisphere contralateral to the motor deficit. SPECT demonstrated normal findings in patients with mild diplegia; bilateral hypoperfusion in the superior motor cortex in patients with moderate di- or tetraplegia; and bilateral reduction of perfusion in the superior motor, inferior motor, prefrontal, and parietal cortices in patients with severe di- or tetraplegia. Results suggest that Tc-99m HMPAO SPECT of the brain is a valuable complementary tool for thorough neurologic assessment in cerebral palsy.

Summary: Toxic causes of seizures are numerous: alcohol and other substances of abuse, drugs, and industrial and household products. However, in the absence of a clearly suggestive history and/or associated symptoms and signs, identification of the toxic origin of new-onset seizures may be extremely difficult. We report here the case of a patient admitted in our hospital after a single generalized tonic-clonic seizure. The remarkable coincidence that a colleague of his, with whom he was working to clean the same workshop, had been admitted 1 week earlier for respiratory distress, coma, and de novo nonconvulsive focal status epilepticus, led us to consider a possible toxicologic etiology. Urine analysis revealed a high nickel concentration, suggestive of acute nickel poisoning. Key Words: Seizures-PoisoningNickel.Toxic causes of seizures are numerous: alcohol and other substances of abuse, drugs, and industrial and household products. However, in the absence of a clearly suggestive history and/or associated symptoms and signs, identification of the toxic origin of new-onset seizures may be extremely difficult. We report here the case of a patient admitted in our hospital after a single generalized tonic-clonic seizure. The remarkable coincidence that a colleague of his, with whom he was working to clean the same workshop, had been admitted 1 week earlier for respiratory distress, coma, and de novo nonconvulsive focal status epilepticus, led us to suspect a possible common toxic origin. CASE REPORTThe patient was a 43-year-old man admitted to our hospital after an inaugural generalized tonic-clonic seizure. His medical and surgical history was unremarkable. The patient did not take or had not recently stopped any medication. He did not abuse alcohol or any other substance and did not recently modify his sleep or food habits. No familial history of epilepsy was known. He had worked for a couple of weeks in a car body-repair workshop where he was cleaning the ceilings of the building. On admission, physical and neurologic examinations were normal, Accepted January 27, 2005. Address correspondence and reprint requests to Dr. D. De Bels at Intensive care Unit, Salle 92, Brugmann University Hospital, Free University of Brussels, 4 Van Gehuchten Plein, B 1020 Brussels, Belgium. E-mail: david.debels@chu-brugmann.be except for a mild drowsiness attributed to a postictal state. No meningeal signs were seen. Prolactin and lactate levels were high on admission, 36.8 ng/ml (2.5-11) and 122.8 mg/dl (9-16), respectively. HbCO was normal (<5%). Glycemia and other routine blood analyses were within normal values. EEG performed a few hours later showed diffuse slow waves. Brain CT and MRI scans were normal. A diagnosis of first idiopathic generalized seizure was presumed, until we were informed that a colleague of the patient, with whom he was working to clean the same workshop, had been admitted 1 week earlier in the same hospital for respiratory distress, coma, and de novo nonconvulsant focal status epilepticus [global aphasia a...

Auto-immune encephalitis is likely underdiagnosed in adolescents. In their most severe presentation, seizures may be resistant to a large number of anti-epileptic drugs, and the clinical improvement seems to be mainly because of the immunomodulatory therapy. Relapse is possible, as well as the delayed development of a teratoma or other tumor.