Involvement of brain structures in childhood epilepsy with centrotemporal spikes

Abstract

Background We aimed to investigate electroencephalography (EEG)‐functional magnetic resonance imaging (fMRI) findings to elucidate the interictal epileptiform discharge (IED)‐related functional alterations in deep brain structures and the neocortex in childhood epilepsy with centrotemporal spikes (CECTS). Methods Ten children with CECTS (median age 8.2 years), referred to our hospital within a year of onset, were eligible for inclusion. They underwent EEG‐fMRI recording during sleep. Llongitudinal evaluations, including medical examinations, intelligence tests, and questionnaires about developmental disabilities, were performed. The initial evaluation was performed at the same time as the EEG‐fMRI, and the second evaluation was performed over 2 years after the initial evaluation. Results Three children were unable to maintain sleep during the EEG‐fMRI recording, and the remaining seven children were eligible for further assessment. All patients showed unilateral‐dominant centrotemporal spikes during scans. One patient had only positive hemodynamic responses, while the others had both positive and negative hemodynamic responses. All patients showed IED‐related hemodynamic responses in the bilateral neocortex. For deep brain structures, IED‐related hemodynamic responses were observed in the cingulate gyrus (n = 4), basal ganglia (n = 3), thalamus (n = 2), and default mode network (n = 1). Seizure frequencies at the second evaluation were infrequent or absent, and the longitudinal results of intelligence tests and questionnaires were within normal ranges. Conclusions We demonstrated that IEDs affect broad brain areas, including deep brain structures such as the cingulate gyrus, basal ganglia, and thalamus. Deep brain structures may play an important role in the pathophysiology of CECTS.

The thalamus and basal ganglia are smaller in children with epilepsy after perinatal stroke

“…A study of patients with different medically intractable focal epilepsies, including childhood-onset epilepsies, found changes in tissue properties in the otherwise normal appearing thalamus, pallidum, caudate nucleus, and nucleus accumbens, with ipsilateral predominance and thalamic preference ( 38 ). Regarding childhood epilepsies, changes in bilateral thalamic and other deep brain structures are described in generalized epilepsy syndromes, localized epilepsies, and self-limited childhood epilepsies ( 39 , 40 ).…”

Involvement of the Thalamus, Hippocampus, and Brainstem in Hypsarrhythmia of West Syndrome: Simultaneous Recordings of Electroencephalography and fMRI Study

“…MR images were obtained using a Magnetom Verio (Siemens) 3T scanner with a 32-channel head coil using the same protocol as in previous studies. 9 fMRIs were recorded in a single, continuous session for 15 minutes using a T2-weighted gradient-echo echoplanar imaging sequence with the following imaging parameters: TR, 2.5 seconds; TE, 30 ms; FOV, 192 mm; matrix dimension, 64 Â 64; 39 transverse slices with a 0.5-mm interslice interval and 3-mm thickness; flip angle, 80°; and a total of 360 volumes. EEGs and electrocardiograms were recorded simultaneously during fMRI scans using an MR imaging-compatible system (GES 400 MR, Electrical Geodesics, EGI; https://www.egi.com/).…”