Document Detail


Ictogenesis and symptomatogenesis of gelastic seizures in hypothalamic hamartomas: an ictal SPECT study.
MedLine Citation:
PMID:  20887368     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To topographically localize the ictogenic zone within hypothalamic hamartomas (HHs) and the symptomatogenic zone for gelastic seizure (GS), we analyzed data from both interictal and ictal single photon emission computed tomography (SPECT).
METHODS: Ictal SPECT was performed immediately after GS onset in 21 patients with HH (aged 2-36 years, mean 13.8 years) who underwent stereotactic radiofrequency thermocoagulation (SRT). SPECT data were statistically analyzed by means of subtraction ictal SPECT coregistered to magnetic resonance imaging (MRI) (SISCOM) and statistical parametric mapping (SPM). Topographic localization of ictal hyperperfusion areas was evaluated.
RESULTS: SISCOM obtained in 27 studies demonstrated ictal hyperperfusion in the HH interface zone in 16 studies of 13 patients (hot HH group). In these patients, HHs were significantly larger than those without hyperperfusion of HH in 11 studies of 8 patients (21.4 ± 10.3 vs. 12.3 ± 7.3 mm in diameter, p < 0.05, t-test). In all patients and in the hot HH group, SPM group analysis of individual differences between interictal and ictal data revealed significantly (p < 0.001) hyperperfused areas in the ipsilateral hypothalamus, mediodorsal (MD) nucleus of the thalamus and putamen, bilateral pontine tegmentum, and contralateral inferior semilunar lobule of the cerebellum. There was no hyperperfusion in the mammillothalamocingulate pathway.
DISCUSSION: The present study confirmed that ictogenesis occurs in the HH interface zone, which should accordingly be the target for SRT. We suggest that a thalamopontocerebellar circuit plays an important role for stereotypical and automatic symptomatogenesis of GS and that the hypothalamus and MD nucleus of the thalamus are potentially involved in epileptic encephalopathy.
Authors:
Shigeki Kameyama; Hiroshi Masuda; Hiroatsu Murakami
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-09-30
Journal Detail:
Title:  Epilepsia     Volume:  51     ISSN:  1528-1167     ISO Abbreviation:  Epilepsia     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-27     Completed Date:  2011-01-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2983306R     Medline TA:  Epilepsia     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2270-9     Citation Subset:  IM    
Copyright Information:
Wiley Periodicals, Inc. © 2010 International League Against Epilepsy.
Affiliation:
Department of Functional Neurosurgery, Epilepsy Center, Nishi-Niigata Chuo National Hospital, Niigata, Japan. kameyama@masa.go.jp
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Brain Mapping
Child
Child, Preschool
Cysteine / analogs & derivatives,  diagnostic use
Dominance, Cerebral / physiology
Electroencephalography
Epilepsies, Partial / physiopathology*,  radionuclide imaging*,  surgery
Female
Hamartoma / physiopathology,  radionuclide imaging,  surgery
Humans
Hypothalamic Diseases / physiopathology,  radionuclide imaging,  surgery
Hypothalamus / physiopathology,  radionuclide imaging,  surgery
Image Processing, Computer-Assisted*
Imaging, Three-Dimensional*
Magnetic Resonance Imaging*
Male
Organotechnetium Compounds / diagnostic use
Radiosurgery
Regional Blood Flow / physiology
Signal Processing, Computer-Assisted
Software
Subtraction Technique*
Tomography, Emission-Computed, Single-Photon*
Young Adult
Chemical
Reg. No./Substance:
0/Organotechnetium Compounds; 0/technetium Tc 99m bicisate; 52-90-4/Cysteine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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