Cerebral regional hypometabolism caused by propofol-induced sedation in children with severe myoclonic epilepsy: a study using fluorodeoxyglucose positron emission tomography and statistical parametric mapping

Juengling, Freimut D.; Kassubek, Jan; Bouar, Heike Martens-Le; Reinhardt, Michaël; Krause, Thomas; Nitzsche, Egbert U.; Moser, E.; Korinthenberg, Rudolf

doi:10.1016/s0304-3940(02)01060-1

Cited by 13 publications

(8 citation statements)

References 9 publications

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“…Furthermore it has been reported that cerebral blood flow could not be increased by a hypertensor during propofol anaesthesia. 15 It has also been reported that ET CO2 is correlated with cerebral blood flow and metabolism, as shown by a slight decrease in cerebral glucose metabolism when ET CO2 fell from 40 to 30 mmHg; 16 however, no statistical significance was reported for this correlation. 14 In the present study, ET CO2 was found to be 5 mmHg higher in the awake state than the unconsciousness state, implying that ET CO2 did not fundamentally influence the current results.…”

Section: Discussionmentioning

confidence: 98%

Imaging the Effects of Propofol on Human Cerebral Glucose Metabolism Using Positron Emission Tomography

et al. 2008

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The effects of propofol on glucose metabolism in different cerebral regions were observed, using positron emission tomography (PET) technology, to determine a possible cerebral target region. Seven healthy volunteers were injected with 18 F-fluorodeoxyglucose developing agent for PET scanning whilst awake (control group T1), during sedation (induced by 1.5 µg/ml propofol administered by target controlled injection [TCI], group T2) and when unconsciousness (induced by 2.5 µg/ml propofol administered by TCI, group T3). Whole brain glucose metabolism was reduced during propofol anaesthesia; this was initially observed in the cortical areas at the lower dose of propofol (group T2) but extended to the subcortical regions, especially the thalamus and hippocampus, at the higher dose (group T3). This suggests that these regions of the brain might be important targets that are susceptible to propofol.

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Section: Discussionmentioning

confidence: 98%

Imaging the Effects of Propofol on Human Cerebral Glucose Metabolism Using Positron Emission Tomography

et al. 2008

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“…However, we had previously shown that SPM can reliably detect hypometabolic areas in epileptic children older than 6 y using healthy young adults as a control (21). Subsequently, several other studies successfully used adult controls to perform SPM analysis in a pediatric population with various disorders (30,35–38). Further, the results of the SPM analysis in the present study were generally consistent with the results of visual analysis.…”

Section: Discussionmentioning

confidence: 99%

Objective Detection of Epileptic Foci by¹⁸F-FDG PET in Children Undergoing Epilepsy Surgery

Kumar¹,

Juhász²,

Asano³

et al. 2010

J Nucl Med

118

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PET has been used for the presurgical localization of epileptic foci for more than 20 y; still, its clinical role in children with intractable epilepsy remains unclear, largely because of variable analytic approaches and different outcome measures. The purpose of the present study was to evaluate and optimize the performance (lateralization and lobar localization value of epileptic foci) of objective voxel-based analysis of 18F-FDG PET scans in a pediatric epilepsy population. Methods Twenty children with intractable focal epilepsy (mean age ± SD, 11 ± 4 y; age range, 6–18 y) who underwent interictal 18F-FDG PET, followed by 2-stage epilepsy surgery with chronic subdural electrocorticographic monitoring, and were seizure-free after surgery were included in this study. PET images were analyzed using both a visual-analysis and a statistical parametric mapping (SPM) method. Lateralization value and performance of lobar localization (in lateral and medial surfaces of all lobes, total of 8 regions in each epileptic hemisphere), calculated for 3 different statistical thresholds, were determined against intracranial electrocorticography-determined seizure-onset region and surgical resection site. Results SPM using a statistical threshold of P less than 0.001 provided 100% correct lateralization, which was better than visual assessment (90%). Although visual and SPM analyses (with both P < 0.001 and P < 0.0001 thresholds) performed similarly well (with a sensitivity and specificity of 74%or above) in the localization of seizure-onset regions, SPM detected 7 of 9 seizure-onset regions, mostly in medial cortices, that were missed by visual assessment. Also, SPM performed equally well in both hemispheres, compared with visual analysis, which performed better in the left hemisphere. No statistical difference in performance was observed between visual and SPM analyses of children with abnormal versus normal MRI findings or of children with gliosis versus developmental pathology. Clinical variables, such as age, duration of epilepsy, age of seizure onset, and time between PET and last seizure, showed no correlation with sensitivity or specificity of either visual analysis or SPM analysis. Conclusion SPM analysis, using a young adult control group, can be used as a complementary objective analytic method in identifying epileptogenic lobar regions by 18F-FDG PET in children older than 6 y.

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“…Brain FDG‐PET was performed according to the European Association of Nuclear Medicine procedure guidelines (Bartenstein et al., 2002). Integrated PET and computed tomography (CT) images were recorded during the interictal state, using hybrid PET/CT systems: a Biograph camera in Nancy (Siemens, Knoxville, TN, U.S.A.) and a Siemens CTI ECAT EXACT tomograph in Freiburg (Siemens, Erlangen, Germany) as described previously (Juengling et al., 2002; Jennesson et al., 2010). No seizure was observed during the uptake period.…”

Section: Methodsmentioning

confidence: 99%

Intracranial evaluation of the epileptogenic zone in regional infrasylvian polymicrogyria

et al. 2012

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SUMMARYPurpose: To define the relationship between the epileptogenic zone and the polymicrogyric area using intracranial electroencephalography (EEG) recordings in patients with structural epilepsy associated with regional infrasylvian polymicrogyria (PMG). Methods: We retrospectively reviewed the medical charts, scalp, and intracranial video-EEG recordings, neuroimaging findings, and neuropsychological evaluations of four patients with refractory temporal lobe epilepsy related to PMG who consequently underwent resective surgery. Key Findings: High-resolution magnetic resonance imaging (MRI) revealed temporal lobe PMG in all cases, accompanied by hippocampal malrotation and closed lip schizencephaly in 3/4 cases, respectively. In intracranial recordings, interictal spike activity was localized within the PMG in only 2/4 and within the amygdala, hippocampus, and entorhinal cortex in all cases. In the first patient, two epileptogenic networks coexisted: the prevailing network initially involved the mesial temporal structures with spread to the anterior PMG; the secondary network successively involved the anterior part of the PMG and later the mesial temporal structures. In the second patient, the epileptogenic network was limited to the mesial temporal structures, fully sparing the PMG. In the third patient, the epileptogenic network first involved the mesial temporal structures and later the PMG. Conversely, in the last case, part of the PMG harbored an epileptogenic network that propagated to the mesial temporal structures. Consistent with these findings a favorable outcome (Engel class I in three of four patients; Engel class II in one of four) at last follow-up was obtained by a resection involving parts of the PMG cortex in three of four and anteromesial temporal lobe structures in another three of four cases. Significance: Infrasylvian PMG displays a heterogeneous epileptogenicity and is occasionally and partially involved in the epileptogenic zone that commonly includes the mesial temporal structures. Our results highlight the intricate interrelations between the MRI-detectable lesion and the epileptogenic zone as delineated by intracranial recordings. Seizure freedom can be accomplished as a result of a meticulous intracranial study guiding a tailored resection that may spare part of the PMG.

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Cerebral regional hypometabolism caused by propofol-induced sedation in children with severe myoclonic epilepsy: a study using fluorodeoxyglucose positron emission tomography and statistical parametric mapping

Cited by 13 publications

References 9 publications

Imaging the Effects of Propofol on Human Cerebral Glucose Metabolism Using Positron Emission Tomography

Imaging the Effects of Propofol on Human Cerebral Glucose Metabolism Using Positron Emission Tomography

Objective Detection of Epileptic Foci by¹⁸F-FDG PET in Children Undergoing Epilepsy Surgery

Intracranial evaluation of the epileptogenic zone in regional infrasylvian polymicrogyria

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Cerebral regional hypometabolism caused by propofol-induced sedation in children with severe myoclonic epilepsy: a study using fluorodeoxyglucose positron emission tomography and statistical parametric mapping

Cited by 13 publications

References 9 publications

Imaging the Effects of Propofol on Human Cerebral Glucose Metabolism Using Positron Emission Tomography

Imaging the Effects of Propofol on Human Cerebral Glucose Metabolism Using Positron Emission Tomography

Objective Detection of Epileptic Foci by18F-FDG PET in Children Undergoing Epilepsy Surgery

Intracranial evaluation of the epileptogenic zone in regional infrasylvian polymicrogyria

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Objective Detection of Epileptic Foci by¹⁸F-FDG PET in Children Undergoing Epilepsy Surgery