Early thalamic injury associated with epilepsy and continuous spike-wave during slow sleep.
OBJECTIVE
Mechanisms inducing continuous spike-wave during slow sleep (CSWS) in encephalopathy with electrical status epilepticus during sleep are still unclear. Recently, some sporadic cases with early thalamic injury associated with CSWS have been reported. The aim of the study was to investigate in a population of patients with an early thalamic injury the presence of an activation of paroxysmal activities during sleep, their characteristics, and possible relations to neuroimaging and neuropsychological features.


METHODS
Thirty-two patients with prenatal or perinatal thalamic injuries, mostly due to a vascular mechanisms, were fully examined, including neuroimaging, EEG monitoring, and cognitive follow-up.


CONCLUSIONS
Twenty-nine of 32 patients showed major sleep EEG activation. Among these 29 patients, two different groups were distinguished: the first included the more or less typical CSWS (12 cases), generally with symmetry of spike and waves (SWs) and often with no spindle at all. The other cases had an usual asymmetry of SWs and presence or reduction of spindles, plus other atypical features concerning synchronism and morphology of SWs. Behavioral disorders were significantly more present in patients with a true CSWS; their improvement (and in one case of the three thoroughly followed the improvement of cognitive competence) paralleled the disappearance of CSWS. The generally predominant injury of the lateral aspect of the thalamus included reticular nucleus and ventral nuclei. An imbalance of gamma-aminobutyric acid (GABA)(B)--versus GABA(A)--mediated receptors may be evoked as a cofactor predisposing to CSWS.
Guzzetta
Francesco
F
Department of Medical and Surgical Pediatrics and Developmental Neurosciences, Catholic University, Rome, Italy. fguzzetta@rm.unicatt.it
Battaglia
Domenica
D
Veredice
Chiara
C
Donvito
Valeria
V
Pane
Marika
M
Lettori
Donatella
D
Chiricozzi
Francesca
F
Chieffo
Daniela
D
Tartaglione
Tommaso
T
Dravet
Charlotte
C
D000293:Adolescent; D001930:Brain Injuries / Q000151:congenital / Q000503:physiopathology*; D002540:Cerebral Cortex / Q000503:physiopathology; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000503:physiopathology; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology; D004569:Electroencephalography / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009483:Neuropsychological Tests; D017286:Polysomnography; D011247:Pregnancy; D049188:Prenatal Injuries; D012890:Sleep / Q000502:physiology*; D012894:Sleep Stages / Q000502:physiology; D013226:Status Epilepticus / Q000175:diagnosis / Q000503:physiopathology*; D013788:Thalamus / Q000293:injuries / Q000503:physiopathology*; D014851:Wakefulness / Q000502:physiology