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1.
Ictal Patterns of Cerebral Glucose Utilization in Children with Epilepsy   总被引:9,自引:9,他引:6  
Summary: To determine seizure propagation patterns, we analyzed ictal positron emission tomography (PET) studies of regional cerebral glucose utilization in 18 children (11 male and 7 female aged weeks to 16 years) with epilepsy (excluding infantile spasms IS). Three major metabolic patterns were determined based on degree and type of subcortical involvement: Nine children had type I; asymmetric glucose metabolism of striatum and thalamus. Of these, the 7 oldest children showed unilateral cortical hypermetabolism (always including frontal cortex) and crossed cerebellar hypermetabolism. Two infants (aged <1 year) had a similar ictal PET pattern but no cerebellar asymmetry, presumably owing to immaturity of corticopontocerebellar projections. Five children had type II, symmetric metabolic abnormalities of striatum and thalamus; this pattern was accompanied by hippocampal or insular cortex hypermetabolism, diffuse neocortical hypometabolism, and absence of any cerebellar abnormality. Four children had type III, hypermetabolism restricted to cerebral cortex. This classification can accommodate ictal PET and single photon emission computed tomography (SPECT) patterns described by other investigators. Future studies should be directed at the clinical relevance of this classification, particularly with regard to epilepsy surgery.  相似文献
2.
Complex Partial Seizures: Cerebellar Metabolism   总被引:7,自引:7,他引:2  
We used positron emission tomography (PET) with [18F]2-deoxyglucose to study cerebellar glucose metabolism (LCMRglu) and the effect of phenytoin (PHT) in 42 patients with complex partial seizures (CPS), and 12 normal controls. Mean +/- SD patient LCMRglu was 6.9 +/- 1.8 mg glucose/100 g/min (left = right), significantly lower than control values of 8.5 +/- 1.8 (left, p less than 0.006), and 8.3 +/- 1.6 (right, p less than 0.02). Only four patients had cerebellar atrophy on CT/MRI; cerebellar LCMRglu in these was 5.5 +/- 1.5 (p = 0.054 vs. total patient sample). Patients with unilateral temporal hypometabolism or EEG foci did not have lateralized cerebellar hypometabolism. Patients receiving phenytoin (PHT) at the time of scan and patients with less than 5 years total PHT exposure had lower LCMRglu, but the differences were not significant. There were weak inverse correlations between PHT level and cerebellar LCMRglu in patients receiving PHT (r = -0.36; 0.05 less than p less than 0.1), as well as between length of illness and LCMRglu (r = -0.22; 0.05 less than p less than 0.1). Patients with complex partial seizures have cerebellar hypometabolism that is bilateral and due only in part to the effect of PHT.  相似文献
3.
Hippocampal volume and glucose metabolism in temporal lobe epileptic foci   总被引:5,自引:5,他引:1  
PURPOSE: Reports conflict on the relation of glucose metabolism to hippocampal volume in temporal lobe foci. Previous studies usually have used side-side ratios rather than regional metabolic rates. METHODS: We measured hippocampal volume and glucose metabolism in 37 patients with temporal epileptogenic zones identified by ictal video-EEG telemetry. Metabolic rates were normalized to global brain mean. RESULTS: Both 18-fluoro-2-deoxyglucose-PET and volumetric MRI lateralized the epileptic focus determined by ictal video-EEG. There were significant correlations between left-right metabolic asymmetry and hippocampal formation volume left-right ratios. Comparisons between normalized metabolism and hippocampal formation volume, ignoring the side of the epileptic focus, showed significant relations between left hippocampal volume and left inferior lateral temporal metabolism, right hippocampus and right inferior mesial temporal, and left hippocampus and left inferior mesial temporal metabolism. In contrast, when normalized metabolism was compared with hippocampal volume in the epileptic focus, no relation was found. CONCLUSIONS: Our study suggests that the relation between hippocampal volume and glucose metabolism breaks down in epileptic foci and that hypometabolism is not dependent on neuronal loss. It is consistent with data suggesting that hypometabolism is an independent predictor of surgical outcome.  相似文献
4.
5.
Summary: Purpose : We sought to determine the cause of cerebellar dysfunction in epilepsy and whether this dysfunction was directly related to seizures.
Methods : Cerebellar metabolism was evaluated in 48 patients with a well-defined region of seizure onset and with corresponding hypometabolism. Regions of interest (ROI) were drawn according to a standardized template. If the ROI/honepileptogenic cortex count rate ratio was outside the 95% confidence interval (CI) of controls, the ROI was defined as abnormal. The ratios from cerebellar hemispheres (defined as ipsi- or contralateral to the seizure onset region), were compared among controls (n = 8); patients who had seizure onsets and corresponding hypometabolism mesially in a temporal lobe (patient group 1, n = 19); patients whose seizures had onset mesially in a temporal lobe but spread rapidly to the ipsilateral frontal lobe and who had hypometabolism both in the affected temporal lobe and frontal lobe (patient group 2, n = 23); and patients who had seizure onsets and corresponding hypometabolism in the frontal lobe (patient group 3, n = 6).
Results : Significant hypometabolism was noted in the contralateral cerebellum of patients in groups 2 and 3 [p = 0.007 and p = 0.008, respectively; two-way analysis of variance (ANOVA)]. In contrast, patients in group 1 tended to have lower values in the ipsilateral cerebellum (p = 0.057).
Conclusions : The observed cerebellar changes are consistent with animal data showing that cerebellar connections to frontal lobes are numerous and crossed, whereas the connections to mesial temporal lobes are less abundant, bilateral, with an ipsilateral predominance. The difference between the two groups of patients with mesial temporal seizures suggests that cerebellar dysfunction in partial epilepsy, at least to a certain extent, is related to mechanisms involved in seizure generation and spread.  相似文献
6.
Epilepsy duration, febrile seizures, and cerebral glucose metabolism   总被引:2,自引:2,他引:1  
PURPOSE: Studies using magnetic resonance imaging have shown that reduced hippocampal volume is associated with a history of febrile seizures, the duration of epilepsy, and the number of generalized tonic-clonic seizures. It is uncertain whether these factors have the same influence on functional as on structural measures of the integrity of the epileptogenic zone. METHODS: We used positron emission tomography (PET) with fluorine 18 2-deoxyglucose to study 91 patients with temporal lobe seizure foci localized by ictal video-EEG. PET was performed in the awake interictal resting state with ears plugged and eyes patched. We recorded surface EEG during injection (5 mCi) and the 30-min uptake period. We used a standard template to analyze PET scans. RESULTS: A significant negative relation was found between the duration of epilepsy and hippocampal glucose metabolism ipsilateral to the epileptic focus. Patients with a history of either any febrile seizures, or complex, or prolonged febrile seizures, did not have greater hypometabolism ipsilateral to the epileptic focus than did patients without a febrile seizure history. We found no effect of generalized tonic-clonic seizure history. CONCLUSIONS: Longer epilepsy duration is associated with greater hypometabolism, suggesting that epilepsy is a progressive disease.  相似文献
7.
糖调节受损与颅内外动脉闭塞性病变的相关性   总被引:2,自引:0,他引:2  
目的观察非糖尿病缺血性卒中患者糖调节受损(IGR)的发病率,并研究IGR与颅内外动脉粥样硬化性狭窄或闭塞(简称颅内外动脉闭塞性病变)的相关性。方法以非糖尿病且空腹血糖水平(FPG)〈7.0mmol/L的缺血性卒中患者为研究对象(病程3周至半年)。依据经颅多普勒超声和头颅磁共振血管成像结果,将被研究者分为狭窄组(大血管病变组)与非狭窄组(小血管病变组);依据口服葡萄糖耐量试验(OGTT),5.6mmol/L≤FPG〈7.0mmol/L和(或)7.8mmol/L≤OGTT2h血糖〈11.1mmol/L者诊断为IGR,OGTT2h血糖≥11.1mmol/L者诊断为糖尿病。结果(1)160例缺血性卒中患者中IGR及糖尿病的患病率分别为35.6%(57/160)和21.8%(35/160);其中狭窄组为40.9%(45/110)和26.3%(29/110),非狭窄组为24.0%(12/50)和12.0%(6/50),两组比较前者明显高于后者(P=0.038,0.042);(2)Logistic回归分析显示OGTT2h血糖、低高密度脂蛋白胆固醇及缺血性卒中家族史为颅内外动脉闭塞性病变的独立危险因素(OR=1.362、0.149、7.518,P=0.019、0.003、0.002)。结论经OGTT发现,IGR在缺血性卒中患者中普遍存在,尤其伴有颅内外动脉闭塞性病变者更为常见。而OGTT2h血糖是IGR患者导致颅内外动脉闭塞性病变的独立危险因素。  相似文献
8.
Exo-focal postischemic neuronal death in the rat brain   总被引:1,自引:1,他引:14  
We describe delayed neuronal damage in ipsilateral areas remote from the ischemic area of rat brain after transient focal ischemia induced by embolization of the right middle cerebral artery (MCA). After 15, 30, 60 and 90 min of MCA occlusion, recirculation was achieved by removal of the embolus. Chronological changes in the distribution of the neuronal damage were determined by using the 45Ca autoradiographic technique and the histological method, and the mechanism involved was investigated by measuring local cerebral glucose metabolism. Depending on the duration of ischemia, 45Ca accumulation extended to the lateral segment of the caudate putamen and to the cerebral cortex, both supplied by the occluded MCA. Moreover, 3 days after ischemic insult, 45Ca had accumulated in the ipsilateral substantia nigra and ventral posterior nucleus of the thalamus. Histological examination revealed that the neurons in both areas suffered damage and were selectively reduced in number. Cerebral glucose utilization decreased in the thalamus, but increased approximately 30% (P less than 0.01) in the substantia nigra compared with the value in the corresponding contralateral area. Both areas lie outside the ischemic area, but have transsynaptic connections with the ischemic focus. Based on the present study, we suggest that the mechanisms of delayed neuronal death in these two remote areas may not be identical, but that this phenomenon may be caused by a transsynaptic process associated with the ischemic focus.  相似文献
9.
帕金森病相关脑葡萄糖代谢模式的研究进展   总被引:1,自引:1,他引:0  
神经影像学的发展极大推进了对神经退行性疾病(如帕金森病)的理解。对帕金森病患者脑葡萄糖代谢影像学数据进行分析可得到和运动症状相关的异常葡萄糖代谢模式,该模式作为一种客观工具可用于帕金森病的诊断、鉴别诊断、疾病进展及治疗效果的评估等,为帕金森病等运动障碍性疾病提供有效的临床生物学标记物。  相似文献
10.
缺血性脑血管病患者颈动脉病变与糖代谢的关系   总被引:1,自引:0,他引:1  
目的探讨缺血性脑血管病(ICVD)患者颈动脉病变与糖代谢的关系。方法 122例ICVD患者根据葡萄糖耐量试验(OGTT)结果分为糖耐量正常(NGT)组(44例)、糖耐量减低(IGT)组(27例)及糖尿病(DM)组(51例),对各组患者进行颈动脉彩色多普勒超声检查,并对3组间颈动脉病变情况进行分析。结果 DM组年龄明显高于NGT组(P<0.05),IGT组三酰甘油(TG)水平明显高于NGT组(P<0.05)。3组间负荷后血糖峰值差(PGS)、0~120 min血糖-时间曲线下面积(AUC0-120)、OGTT 2 h血糖水平差异有统计学意义(均P<0.01)。DM组和IGT组颈动脉粥样斑块不稳定性及管腔狭窄发生率高于NGT组(均P<0.05)。糖耐量异常的ICVD患者颈动脉狭窄程度与AUC0-120、负荷后血糖最大值(PGmax)及PGS呈正相关(r=0.231,r=0.168,r=0.191;均P<0.05)。结论 ICVD患者随糖代谢异常程度增加,其颈动脉的病变程度加重。  相似文献
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