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Thalamic abnormalities in children with continuous spike‐wave during slow‐wave sleep: An F‐18‐fluorodeoxyglucose positron emission tomography perspective
Author(s) -
Agarwal Rajkumar,
Kumar Ajay,
Tiwari Vijay N.,
Chugani Harry
Publication year - 2016
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13278
Subject(s) - thalamus , positron emission tomography , abnormality , medicine , fluorodeoxyglucose , magnetic resonance imaging , epilepsy , nuclear medicine , psychology , radiology , psychiatry
Summary Objective Thalamic injury has been implicated in the development of continuous spike‐wave during slow‐wave sleep ( CSWS ) in children with epilepsy. We studied thalamic abnormalities in children with CSWS using F‐18‐fluorodeoxyglucose ( FDG )–positron emission tomography ( PET ) imaging. Methods Twenty‐three patients (12 male; mean age 9 years) with CSWS and normal thalami on brain magnetic resonance imaging ( MRI ) underwent FDG ‐ PET . Thalamic glucose metabolism, represented by standardized uptake value normalized to whole brain ( nSUV , RT for right thalamus and LT for left thalamus), and its asymmetry—absolute asymmetry index ( AAI ): ¦( RT ‐ LT )¦*100/[( RT + LT )/2]—was calculated. These values were compared with those from 10 normal healthy controls (five female; mean age 11.1 years). Results Thalamic glucose metabolism was abnormal in 18 patients (78.3%). Thalamic nSUV was decreased (n = 6) or increased (n = 1) bilaterally in seven children without any asymmetry. Abnormal thalamic symmetry [ AAI = 3.7–31.5% (0.8–3.3% in controls)] was seen in 11 children. Of these, six children had a unilateral thalamic metabolic abnormality (increased metabolism, n = 3 and decreased metabolism, n = 3), whereas 5 of 14 children had abnormal asymmetry index with bilaterally normal (n = 4) or increased (n = 1) thalamic metabolism. No clear association of thalamic metabolic abnormalities was seen with the stage of evolution of CSWS (prodromal, acute, or residual) or with the cortical FDG abnormalities. Significance Functional thalamic abnormalities, both unilateral and bilateral, are frequently seen in patients with CSWS . FDG ‐ PET is a sensitive and quantifiable modality to detect these changes.