Neuroimaging and spectroscopy in children with epileptic encephalopathies
a United Medical and
Dental Schools, Guy's Campus, London, UK, b Department of Paediatric
Neurology, Leeds General Infirmary, Leeds, UK
Correspondence to: Dr A P J Parker, Newcomen Centre, Guy's Hospital, London SE1 9RT, UK.
Accepted 9 March 1998
AIMS
To investigate
the nature of the unifocal cortical abnormalities on FDG positron
emission tomography (PET) in children with an epileptic encephalopathy
but no focal abnormality on electroencephalogram or standard magnetic
resonance imaging (MRI).
METHODSRepeat FDG
PET, surface rendered high resolution MRI, and single voxel magnetic
resonance proton spectroscopy of the areas of abnormal metabolism
compared to the contralateral side in 11 children aged 2 to 12 years.
Imaging was repeated after a median of 13 months.
RESULTSVisual
analysis of repeat FDG PET revealed similar abnormalities in 10 of 11 children. Semiquantitative analysis revealed similar sited
abnormalities in eight children. One child with ictal hypermetabolism
initially had an inconsistent second scan. Magnetic resonance spectra
in three children showed the N-acetylaspartate/choline ratio was
lower in the hypometabolic focus than in the reciprocal area on the
opposite side, in two children it was higher, and in one child it was
equal. Surface rendered MRI was normal in seven of eight children, and
showed temporal lobe asymmetry in one.
CONCLUSIONIn children
with established epileptic encephalopathies most hypometabolic
areas on FDG PET are stable over time. While focal neuronal loss is
likely in these areas in some children, microdysplasias or other focal
cortical dysplasias are probable in others.
© 1998 by Archives of Disease in Childhood
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