Ajay Kumar MD, PhD, Presenter: Nothing to Disclose

Rajkumar Agarwal MBBS, Abstract Co-Author: Nothing to Disclose

Vijay Narayan Tiwari MD, PhD, Abstract Co-Author: Nothing to Disclose

Harry T. Chugani MD, Abstract Co-Author: Nothing to Disclose

Thalamic injury has been implicated in the development of continuous spike-wave during slow-wave-sleep (CSWS) in children with epilepsy, which is associated with poor neuro-cognitive outcome. We studied thalamic abnormalities in children with CSWS using FDG-PET imaging.

Twenty patients (11 females; mean age: 8.6 years) with epilepsy and CSWS (excluding Landau-Kleffner syndrome), underwent FDG-PET. Thalamic glucose metabolism, represented by standardized uptake value normalized to whole brain (NSUV), and its asymmetry [absolute asymmetry index (AAI):│(Right-Left)│*200/(Right+Left)] was calculated. These values were compared with those from 10 normal healthy controls (5 females; mean age: 11.1 years).

Thalamic glucose metabolism was abnormal in 17 patients (85%). Significant thalamic asymmetry (AAI=5.5-31.5% (0.8-3.3% in controls); p=0.004) was seen in 9 children. 5/9 children had unilateral [increased (n=2) or decreased (n=3)] and 4/9 had bilateral [increased (n=1) or decreased (n=3)] thalamic abnormality. Thalamic NSUV was decreased (n=7) or increased (n=1) bilaterally in 8 children without any asymmetry. MRI was abnormal in two patients, showing unilateral thalamic atrophy, consistent with severely decreased glucose metabolism. Epilepsy surgery was performed in 6 patients with Engel class-I outcome seen in 3/4 patients with unilateral and 2/2 with bilateral decreased thalamic NSUV. Thalamic metabolism was found to be lower on the side of cortical resection in all children.

Thalamic abnormalities, both uni- and bilateral, are seen in patients with CSWS. FDG-PET is a sensitive and quantifiable modality to detect these changes compared to MRI which is mostly normal. Successful epilepsy surgery is possible in these cases.

Our findings provide further insight into the pathogenetic mechanism behind continuous spike-wave during slow-wave-sleep (CSWS) in children with epilepsy.

Kumar, A, Agarwal, R, Tiwari, V, Chugani, H, Evaluation of Thalamic Abnormalities in Children with Epilepsy and Continuous Spike-wave during Slow-wave-Sleep (CSWS) Using FDG Brain PET.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013410.html