Relationship between brain glucose metabolism positron emission tomography (PET) and electroencephalography (EEG) in children with continuous spike-and-wave activity during slow-wave sleep

We studied the relationship between brain glucose metabolism patterns and objectively measured interictal epileptiform abnormalities in six children with intractable epilepsy and continuous spike-and-wave activity during slow-wave sleep. Five of the six patients showed lateralized positron emission tomographic (PET) findings, with the hemisphere showing a relative increase in glucose metabolism concordant with the presumed origin of the generalized interictal spike activity delineated by quantitative electroencephalographic (EEG) analysis. One of these five patients achieved seizure freedom following cortical resection involving the areas of unilateral multifocal hypermetabolism, and another patient has been approved for cortical resection. The results in the present study add further support to the hypothesis that the generalized spike-waves in most cases of continuous spike-and-wave activity during slow-wave sleep are the result of secondary bilateral synchrony. Resective surgery can be effective in selected patients with uncontrolled seizures associated with continuous spike-and-wave activity during slow-wave sleep provided that there is concordance between focal abnormalities on PET and EEG.