Ictal Patterns of Cerebral Glucose Utilization in Children with Epilepsy

Chugani, Harry T.; Rintahaka, Pertti; Shewmon, D. Alan

doi:10.1111/j.1528-1157.1994.tb02517.x

Cited by 94 publications

(41 citation statements)

References 35 publications

(34 reference statements)

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“…In five term infants with HIE investigated by PET 2-3 d after asphyxia, CMRgl was increased, especially in the basal ganglia, in infants with a poor neurologic outcome (23). Hypermetabolism can also be caused by seizures when measured during the ictal phase (43). None of the infants in our study had seizures on the day of the PET scan.…”

Section: Discussionmentioning

confidence: 70%

Cerebral Glucose Metabolism Measured by Positron Emission Tomography in Term Newborn Infants with Hypoxic Ischemic Encephalopathy

et al. 2001

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Total and regional cerebral glucose metabolism (CMRgl) was measured by positron emission tomography with 2-( 18 F) fluoro-2-deoxy-D-glucose ( 18 FDG) in 20 term infants with hypoxic ischemic encephalopathy (HIE) after perinatal asphyxia. All infants had signs of perinatal distress, and 15 were severely acidotic at birth. Six infants developed mild HIE, twelve moderate HIE, and two severe HIE during their first days of life. The positron emission tomographic scans were performed at 4 -24 d of age (median, 11 d). One hour before scanning, 2-3.7 MBq/kg (54 -100 Ci/kg) 18 FDG was injected i.v. No sedation was used. Quantification of CMRgl was based on a new method employing the glucose metabolism of the erythrocytes, requiring only one blood sample. In all infants, the most metabolically active brain areas were the deep subcortical parts, thalamus, basal ganglia, and sensorimotor cortex. Frontal, temporal, and parietal cortex were less metabolically active in all infants. Total CMRgl was inversely correlated with the severity of HIE (p Ͻ 0.01). Six infants with mild HIE had a mean (range) CMRgl of 55.5 (37.7-100.8) mol·min -1 ·100 g -1 , 11 with moderate HIE had 26.6 (13.0 -65.1) mol·min -1 ·100 g -1 , and two with severe HIE had 10.4 and 15.0 mol·min -1 ·100 g -1 , respectively. Five of six infants who developed cerebral palsy had a mean (range) CMRgl of 18.1 (10.2-31.4) mol·min -1 ·100 g -1 compared with 41.5 (13.0 -100.8) mol·min -1 ·100 g -1 in the infants with no neurologic sequela at 2 y. We conclude that CMRgl measured during the subacute period after perinatal asphyxia in term infants is highly correlated with the severity of HIE and short-term outcome. Birth asphyxia among term infants remains a considerable problem in perinatal medicine with high rates of mortality and handicap (1-4). The clinical grading of HIE after perinatal asphyxia has become a useful prognostic tool in the term infant (5-7). Mild HIE usually results in a normal outcome and severe HIE in either death or CP. However, moderate HIE can result in either CP or a normal outcome (8). Early prediction of future handicap is important when selecting infants for early interventions, which may be possible in the near future (9, 10).Several techniques have been used to investigate the cerebral pathology related to perinatal asphyxia. Cerebral morphology has been evaluated with computed tomography (CT) (11) and magnetic resonance imaging (MRI) (12, 13). Methods capable of detecting functional disturbances, such as phosphorus ( 31 P) magnetic resonance spectroscopy (14) and proton ( 1 H) magnetic resonance spectroscopy (15), have been used to investigate changes in brain energy metabolism during the evolution of the secondary energy failure (16).PET, measuring either cerebral blood flow (17) or CMRgl, has been used in a few studies on newborn infants. The first PET studies with FDG in newborn infants did not allow any quantification, making only relative values possible (18,19

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Section: Discussionmentioning

confidence: 70%

Cerebral Glucose Metabolism Measured by Positron Emission Tomography in Term Newborn Infants with Hypoxic Ischemic Encephalopathy

et al. 2001

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“…Ictal imaging with PET has been primarily limited to a few reports of the serendipitous acquisition of ictal PET data in cases in which the patient experienced a seizure during the period of FDG uptake (1,(13)(14)(15). Planned ictal FDG PET imaging of patients…”

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confidence: 99%

Planned Ictal FDG PET Imaging for Localization of Extratemporal Epileptic Foci

et al. 2000

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Summary:Purpose: This work demonstrates the feasibility of planned ictal positron emission tomography (PET) with ['8F]fluoro-2-deoxy-glucose (FDG) for localization of epileptic activity in patients with frequent partial seizures of extratemporal origin.Methods: lctal PET imaging was performed in four patients (two men and two women, ages 28-61) with continuous or very frequent (every 3-15 min) partial seizures. All patients had abnormalities apparent on magnetic resonance (MR) or computed tomographic (CT) imaging, two with extensive brain lesions that precluded precise localization of the seizure focus with interictal PET or single-photon emission tomography (SPECT) imaging.Results: Ictal PET imaging demonstrated a restricted area of focal hypermetabolism concordant with surface electroencephalographic (EEG) recording in all cases. The PET images were registered to MR imaging data for further anatomic localization of hypermetabolic regions in three cases. The ictal PET data were used to guide neurosurgical intervention in one case.Conclusions: We conclude that planned ictal PET imaging may be a useful and potentially superior approach to ictal SPECT for identifying the epileptic focus in a selected group of patients with continuous or frequent simple partial seizures.

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“…Seizures increase cerebral glucose consumption, as shown by ictal positron emission tomography (PET). 24,25 Increased seizure frequency accelerates this process, provided sufficient glucose supply is offered to the brain. The ketogenic diet reduces the consumption of glucose by the brain and provides ketone bodies as an alternative fuel.…”

Section: Discussionmentioning

confidence: 99%

The ketogenic diet improves recently worsened focal epilepsy

Villeneuve

Pinton

Bahi‐Buisson

et al. 2009

Develop Med Child Neuro

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Aim We observed a dramatic response to the ketogenic diet in several patients with highly refractory epilepsy whose seizure frequency had recently worsened. This study aimed to identify whether this characteristic was a useful indication for the ketogenic diet. Method From the 70 patients who received the ketogenic diet during a 3‐year period at our institution, we retrospectively selected patients with focal epilepsy. There were 22 children, 13 females and nine males, aged from 5 months to 18 years 6 months (mean 6y 9mo, SD 5y 11mo). Fifteen had symptomatic and seven had cryptogenic focal epilepsy. Seizure frequency 1 week before initiating the ketogenic diet was compared with that at 1 month and at the last visit on the diet. Results Eleven patients were responders (defined as reduction of seizures by more than 50%) at 1 month. Responders were higher (p=0.046) in the group with a recent worsening of seizures than in those with stable seizure frequency. Seven patients were still seizure‐free at 6 months on the diet. Tolerability was excellent in 10 patients. Five patients stopped the diet because of early side effects. Interpretation The ketogenic diet may be a valuable therapeutic option for children with pharmacoresistant focal epilepsy, particularly those with a recent deterioration of seizure control and neurological status. Because of its rapid effect, the ketogenic diet may be a useful support to intravenous emergency drugs in such a situation.

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Ictal Patterns of Cerebral Glucose Utilization in Children with Epilepsy

Cited by 94 publications

References 35 publications

Cerebral Glucose Metabolism Measured by Positron Emission Tomography in Term Newborn Infants with Hypoxic Ischemic Encephalopathy

Cerebral Glucose Metabolism Measured by Positron Emission Tomography in Term Newborn Infants with Hypoxic Ischemic Encephalopathy

Planned Ictal FDG PET Imaging for Localization of Extratemporal Epileptic Foci

The ketogenic diet improves recently worsened focal epilepsy

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