ro-16-0154 and Status-Epilepticus

Clinical phenotypic expression of SSADH deficiency is highly heterogeneous, and some infants may develop refractory secondary generalized seizures.. A 9-month-old boy manifested partial seizures, developing severe status epilepticus, and conventional antiepileptic drugs were ineffective. Use of ketamine contributed to the control of status epilepticus, achieving a reduction in frequency of partial seizures, and improving EEG findings without apparent complications. Diffusion-weighted images showed hyperintensities in the bilateral basal ganglia and fornix, and multiple T2 hyperintensity lesions were detected. (123)I-iomazenil (IMZ) SPECT revealed a decrease in binding of (123)I-iomazenil predominantly in the left temporal region by the 18th day of hospitalization. However, repeated IMZ-SPECT on the 46th day of hospitalization demonstrated almost no accumulation across a broad region, sparing the left temporal region. The patient showed rapid regression, refractory myoclonus, and severe progressive brain atrophy.. IMZ-SPECT findings demonstrated reduced benzodiazepine receptor binding and its dynamic changes in an SSADH-deficient patient. Considering the down regulation of the GABAA receptor, ketamine should be included in pharmacotherapeutic strategies for treatment of refractory status epilepticus in SSADH-deficient patients.

Topics: Amino Acid Metabolism, Inborn Errors; Atrophy; Brain; Developmental Disabilities; Diffusion Magnetic Resonance Imaging; Disease Progression; Electroencephalography; Flumazenil; Humans; Infant; Male; Radiopharmaceuticals; Status Epilepticus; Succinate-Semialdehyde Dehydrogenase; Tomography, Emission-Computed, Single-Photon

Topics: Adult; Cerebral Cortex; Female; Flumazenil; Humans; Receptors, GABA-A; Remission, Spontaneous; Status Epilepticus; Tomography, Emission-Computed, Single-Photon

(123)I-iomazenil SPECT is of value in determining an epileptogenic focus, however, transient uptake change has been rarely reported in epileptic disorders. A 78-year-old woman diagnosed as status epilepticus (SE) showed transient reduction in (123)I-iomazenil uptake within the epileptic foci on SPECT images during a couple of weeks. It suggests a seizure-related 'short-term' plasticity in the central benzodiazepine receptors and dynamic change in the regulatory mechanisms of inhibitory neurotransmitter system within the epileptic foci in patients with SE.

Topics: Aged; Biomarkers; Brain; Brain Mapping; Down-Regulation; Female; Flumazenil; gamma-Aminobutyric Acid; Humans; Iodine Radioisotopes; Magnetic Resonance Imaging; Neural Inhibition; Neuronal Plasticity; Predictive Value of Tests; Receptors, GABA-A; Status Epilepticus; Synaptic Transmission; Time Factors; Tomography, Emission-Computed, Single-Photon