title: Thalamic abnormalities in children with continuous spike-wave during slow-wave sleep: An F-18-fluorodeoxyglucose positron emission tomography perspective.
abstract: OBJECTIVE
  Thalamic injury has been implicated in the development of continuous spike-wave during slow-wave sleep (CSWS) in children with epilepsy. We studied thalamic abnormalities in children with CSWS using F-18-fluorodeoxyglucose (FDG)-positron emission tomography (PET) imaging.
  
  
  METHODS
  Twenty-three patients (12 male; mean age 9 years) with CSWS and normal thalami on brain magnetic resonance imaging (MRI) underwent FDG-PET. Thalamic glucose metabolism, represented by standardized uptake value normalized to whole brain (nSUV, RT for right thalamus and LT for left thalamus), and its asymmetry--absolute asymmetry index (AAI): ¦(RT-LT)¦*100/[(RT+LT)/2]--was calculated. These values were compared with those from 10 normal healthy controls (five female; mean age 11.1 years).
  
  
  RESULTS
  Thalamic glucose metabolism was abnormal in 18 patients (78.3%). Thalamic nSUV was decreased (n = 6) or increased (n = 1) bilaterally in seven children without any asymmetry. Abnormal thalamic symmetry [AAI = 3.7-31.5% (0.8-3.3% in controls)] was seen in 11 children. Of these, six children had a unilateral thalamic metabolic abnormality (increased metabolism, n = 3 and decreased metabolism, n = 3), whereas 5 of 14 children had abnormal asymmetry index with bilaterally normal (n = 4) or increased (n = 1) thalamic metabolism. No clear association of thalamic metabolic abnormalities was seen with the stage of evolution of CSWS (prodromal, acute, or residual) or with the cortical FDG abnormalities.
  
  
  CONCLUSIONS
  Functional thalamic abnormalities, both unilateral and bilateral, are frequently seen in patients with CSWS. FDG-PET is a sensitive and quantifiable modality to detect these changes.
authors.affiliation: Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.|Division of Neurology, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.
authors.forename: Rajkumar
authors.initials: R
authors.lastname: Agarwal
authors.affiliation: Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.|Division of Neurology, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.|Division of Radiology, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.|PET Center, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.|Division of Neurology, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.|PET Center, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.
authors.forename: Vijay N
authors.initials: VN
authors.lastname: Tiwari
authors.affiliation: Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.|Division of Neurology, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.|PET Center, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan, U.S.A.
authors.forename: Harry
authors.initials: H
authors.lastname: Chugani
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012894:Sleep Stages; D012893:Sleep Wake Disorders / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D013788:Thalamus / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Continuous spike-wave during slow-wave sleep; Electrical status epilepticus in sleep; F-18-fluorodeoxyglucose positron emission tomography; Thalamus