Gaillard W D, Kopylev L, Weinstein S, Conry J, Pearl P L, Spanaki M V, Fazilat S, Fazilat S, Venzina L G, Dubovsky E, Theodore W H
Department of Neurology, Children's National Medical Center, The George Washington University School of Medicine, Washington, DC 20010, USA.
Neurology. 2002 Mar 12;58(5):717-22. doi: 10.1212/wnl.58.5.717.
Patients with refractory partial epilepsy often exhibit regional hypometabolism. It is unknown whether the metabolic abnormalities are present at seizure onset or develop over time.
The authors studied 40 children within 1 year of their third unprovoked partial seizure with EEG, MRI, and [(18)F]-fluorodeoxyglucose ((18)FDG)-PET (mean age at seizure onset = 5.8 years, range 0.9 to 11.9 years; mean epilepsy duration = 1.1 years, range 0.3 to 2.3 years; mean number of seizures = 30, range 3 to 200). The authors excluded children with abnormal structural MRI, except four with mesial temporal sclerosis and two with subtle hippocampal dysgenesis. (18)FDG-PET was analyzed with a region of interest template. An absolute asymmetry index, [AI], greater than 0.15 was considered abnormal.
Thirty-three children had a presumptive temporal lobe focus, five frontotemporal, and two frontal. Mean AI for all regions was not different from 10 normal young adults, even when children less likely to have a temporal focus were excluded. Eight of 40 children (20%) had focal hypometabolism, all restricted to the temporal lobe, especially inferior mesial and inferior lateral regions. Abnormalities were ipsilateral to the presumed temporal lobe ictal focus.
Abnormalities of glucose utilization may be less common and profound in children with new-onset partial seizures than in adults with chronic partial epilepsy. Although these patients' prognosis is uncertain, resolution of epilepsy after three documented seizures is uncommon. If the subjects develop a higher incidence of hypometabolism in the future with planned follow-up studies, metabolic dysfunction may be related to persistent epilepsy rather than present at seizure onset.
难治性部分性癫痫患者常表现出局部代谢减低。目前尚不清楚这种代谢异常是在癫痫发作开始时就存在，还是随着时间发展而来。
作者对40名在第三次无诱因部分性癫痫发作1年内的儿童进行了研究，检查项目包括脑电图（EEG）、磁共振成像（MRI）和[18F]氟脱氧葡萄糖（18FDG）正电子发射断层扫描（PET）（癫痫发作开始时的平均年龄为5.8岁，范围0.9至11.9岁；平均癫痫病程为1.1年，范围0.3至2.3年；平均癫痫发作次数为30次，范围3至200次）。作者排除了MRI结构异常的儿童，但4例内侧颞叶硬化和2例轻度海马发育异常的儿童除外。使用感兴趣区模板分析18FDG-PET。绝对不对称指数[AI]大于0.15被认为异常。
33名儿童推测为颞叶病灶，5名额颞叶病灶，2名额叶病灶。所有区域的平均AI与10名正常年轻成年人无差异，即使排除了不太可能有颞叶病灶的儿童也是如此。40名儿童中有8名（20%）有局灶性代谢减低，均局限于颞叶，尤其是内侧下部和外侧下部区域。异常与推测的颞叶发作病灶同侧。
新发部分性癫痫儿童的葡萄糖利用异常可能不如慢性部分性癫痫成人常见和严重。虽然这些患者的预后不确定，但在有三次记录的癫痫发作后癫痫缓解并不常见。如果在未来的计划随访研究中这些受试者出现更高的代谢减低发生率，代谢功能障碍可能与持续性癫痫有关，而不是在癫痫发作开始时就存在。
