Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Department of Pediatric Neurology, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Neuroimage Clin. 2020;26:102227. doi: 10.1016/j.nicl.2020.102227. Epub 2020 Feb 25.
Perinatal thalamic injury is associated with epilepsy with electrical status epilepticus in sleep (ESES). The aim of this study was to prospectively quantify the risk of ESES and to assess neuroimaging predictors of neurodevelopment.
We included patients with perinatal thalamic injury. MRI scans were obtained in the neonatal period, around three months of age and during childhood. Thalamic and total brain volumes were obtained from the three months MRI. Diffusion characteristics were assessed. Sleep EEGs distinguished patients into ESES (spike-wave index (SWI) >85%), ESES-spectrum (SWI 50-85%) or no ESES (SWI < 50%). Serial Intelligence Quotient (IQ)/Developmental Quotient (DQ) scores were obtained during follow-up. Imaging and EEG findings were correlated to neurodevelopmental outcome.
Thirty patients were included. Mean thalamic volume at three months was 8.11 (±1.67) ml and mean total brain volume 526.45 (±88.99) ml. In the prospective cohort (n = 23) 19 patients (83%) developed ESES (-spectrum) abnormalities after a mean follow-up of 96 months. In the univariate analysis, larger thalamic volume, larger total brain volume and lower SWI correlated with higher mean IQ/DQ after 2 years (Pearson's r = 0.74, p = 0.001; Pearson's r = 0.64, p = 0.005; and Spearman's rho -0.44, p = 0.03). In a multivariable mixed model analysis, thalamic volume was a significant predictor of IQ/DQ (coefficient 9.60 [p < 0.001], i.e., corrected for total brain volume and SWI and accounting for repeated measures within patients, a 1 ml higher thalamic volume was associated with a 9.6 points higher IQ). Diffusion characteristics during childhood correlated with IQ/DQ after 2 years.
Perinatal thalamic injury is followed by electrical status epilepticus in sleep in the majority of patients. Thalamic volume and diffusion characteristics correlate to neurodevelopmental outcome.
围产期丘脑损伤与睡眠中电癫痫持续状态（ESES）有关。本研究的目的是前瞻性量化 ESES 的风险，并评估神经影像学预测神经发育的能力。
我们纳入了围产期丘脑损伤的患者。在新生儿期、三个月大时和儿童期获得 MRI 扫描。从三个月的 MRI 中获取丘脑和全脑体积。评估扩散特征。睡眠 EEG 将患者分为 ESES（棘波指数（SWI）>85%）、ESES 谱（SWI 50-85%）或无 ESES（SWI<50%）。在随访期间获得了连续的智商/发育商（DQ）评分。将影像学和 EEG 结果与神经发育结果相关联。
共纳入 30 例患者。三个月时平均丘脑体积为 8.11（±1.67）ml，平均全脑体积为 526.45（±88.99）ml。在前瞻性队列（n=23）中，19 例患者（83%）在平均 96 个月的随访后出现 ESES（-谱）异常。在单变量分析中，较大的丘脑体积、较大的全脑体积和较低的 SWI 与 2 年后较高的平均智商/DQ 相关（Pearson's r=0.74，p=0.001；Pearson's r=0.64，p=0.005；Spearman's rho=-0.44，p=0.03）。在多变量混合模型分析中，丘脑体积是 IQ/DQ 的显著预测因子（系数为 9.60 [p<0.001]，即校正全脑体积和 SWI，并考虑患者内的重复测量，丘脑体积增加 1ml 与 IQ 增加 9.6 分相关）。儿童期的扩散特征与 2 年后的 IQ/DQ 相关。
围产期丘脑损伤后，大多数患者会出现睡眠电癫痫持续状态。丘脑体积和扩散特征与神经发育结果相关。
