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Perfusion network shift during seizures in medial temporal lobe epilepsy
Journal article   Open access   Peer reviewed

Perfusion network shift during seizures in medial temporal lobe epilepsy

Karen M Sequeira, Ali Tabesh, Rup K Sainju, Stacia M DeSantis, Thomas Naselaris, Jane E Joseph, Mark A Ahlman, Kenneth M Spicer, Steve S Glazier, Jonathan C Edwards, …
PloS one, Vol.8(1), pp.e53204-e53204
2013
DOI: 10.1371/journal.pone.0053204
PMCID: PMC3544909
PMID: 23341932
url
https://doi.org/10.1371/journal.pone.0053204View
Published (Version of record) Open Access

Abstract

Medial temporal lobe epilepsy (MTLE) is associated with limbic atrophy involving the hippocampus, peri-hippocampal and extra-temporal structures. While MTLE is related to static structural limbic compromise, it is unknown whether the limbic system undergoes dynamic regional perfusion network alterations during seizures. In this study, we aimed to investigate state specific (i.e. ictal versus interictal) perfusional limbic networks in patients with MTLE. We studied clinical information and single photon emission computed tomography (SPECT) images obtained with intravenous infusion of the radioactive tracer Technetium- Tc 99 m Hexamethylpropyleneamine Oxime (Tc-99 m HMPAO) during ictal and interictal state confirmed by video-electroencephalography (VEEG) in 20 patients with unilateral MTLE (12 left and 8 right MTLE). Pair-wise voxel-based analyses were used to define global changes in tracer between states. Regional tracer uptake was calculated and state specific adjacency matrices were constructed based on regional correlation of uptake across subjects. Graph theoretical measures were applied to investigate global and regional state specific network reconfigurations. A significant increase in tracer uptake was observed during the ictal state in the medial temporal region, cerebellum, thalamus, insula and putamen. From network analyses, we observed a relative decreased correlation between the epileptogenic temporal region and remaining cortex during the interictal state, followed by a surge of cross-correlated perfusion in epileptogenic temporal-limbic structures during a seizure, corresponding to local network integration. These results suggest that MTLE is associated with a state specific perfusion and possibly functional organization consisting of a surge of limbic cross-correlated tracer uptake during a seizure, with a relative disconnection of the epileptogenic temporal lobe in the interictal period. This pattern of state specific shift in metabolic networks in MTLE may improve the understanding of epileptogenesis and neuropsychological impairments associated with MTLE.
Technetium Tc 99m Exametazime Demography Nerve Net - diagnostic imaging Humans Middle Aged Child, Preschool Epilepsy, Temporal Lobe - physiopathology Infant Seizures - complications Seizures - diagnostic imaging Nerve Net - pathology Epilepsy, Temporal Lobe - diagnostic imaging Young Adult Seizures - physiopathology Epilepsy, Temporal Lobe - complications Seizures - pathology Perfusion Radionuclide Imaging Adult Child Epilepsy, Temporal Lobe - pathology Nerve Net - physiopathology

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