Dynamic cortical activity during spasms in three patients with West syndrome: a multichannel near-infrared spectroscopic topography study.
OBJECTIVE
To investigate spatial and temporal cortical activity during clusters of naturally occurring epileptic spasms in patients with West syndrome (WS) by using multichannel near-infrared spectroscopy (mNIRS).


METHODS
Conventional magnetic resonance imaging (MRI) and interictal and ictal single-photon emission computed tomography (SPECT) were carried out in three patients with WS. Thereafter, cortical hemodynamics during naturally occurring epileptic spasms were measured by mNIRS with simultaneous video/electroencephalographic (EEG) monitoring.


RESULTS
Ictal SPECT revealed multiple hyperperfused areas within the cortex. With the use of mNIRS, an increase in regional cerebral blood volume (CBV) was observed in these areas, which is representative of cortical activation. The increase in CBV was accompanied by an increase in the concentrations of both oxy- and deoxyhemoglobin. The following heterogeneous regional changes in CBV during ictus were observed: (a) transient increases that were synchronized with spasms; (b) a gradual increase during an ictal event that fluctuated in synchrony with spasms; and (c) a combination of transient and gradual increases. An increase in regional CBV occurred in multiple areas that were activated either simultaneously or sequentially during an ictal event. Topographic changes in CBV were closely correlated with the phenotype of the spasm.


CONCLUSIONS
During ictal events, multiple cortical areas were activated simultaneously or sequentially. The pattern of cortical activation closely affected the phenotype of the spasm, which suggested that the cortex was involved in the generation of spasms.
Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan. muna@ped.med.tohoku.ac.jp
Mitsutoshi
M
Munakata
Kazuhiro
K
Haginoya
Mamiko
M
Ishitobi
Osamu
O
Sakamoto
Ikuko
I
Sato
Taro
T
Kitamura
Mieko
M
Hirose
Hiroyuki
H
Yokoyama
Kazuie
K
Iinuma
D001931:Brain Mapping; D002540:Cerebral Cortex / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003545:Cysteine / Q000031:analogs & derivatives*; D004569:Electroencephalography / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008991:Monitoring, Physiologic; D015609:Organotechnetium Compounds; D012039:Regional Blood Flow; D013036:Spasms, Infantile / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D019265:Spectroscopy, Near-Infrared / Q000706:statistics & numerical data*; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data; D014743:Videotape Recording
D015609:Organotechnetium Compounds; C059659:technetium Tc 99m bicisate; D003545:Cysteine