technetium-tc-99m-exametazime and Epilepsies--Myoclonic

The role of thalamus and brainstem in generalized epilepsy has been suggested in previous studies. The aim of the present study was to assess regional cerebral blood flow (rCBF) abnormality in juvenile myoclonic epilepsy (JME) patients.. (99m)Tc-ethylcysteinate dimer brain single photon emission computed tomography (SPECT) was performed in 19 drug naive JME patients and 25 normal controls with the similar age and gender distribution. Differences of rCBF between a JME group and a normal control group were examined by the statistical parametric mapping of brain SPECT images using independent t test. The regression analyses in SPM were also performed between rCBF and the age of seizure onset or the disease duration in JME group.. Compared to normal controls, the JME group showed a significant rCBF reduction in bilateral thalami, red nucleus, midbrain, pons, left hippocampus, and in the cerebelli (FDR corrected p < 0.01) whereas rCBF increase in the left superior frontal gyrus (uncorrected p < 0.001 but FDR corrected p > 0.05). Disease duration was negatively correlated with rCBF in bilateral frontal cortices, caudate nuclei, brainstem and cerebellar tonsils.. Our results suggest that abnormal neural networks in the thalamus, hippocampus, brainstem and cerebellum are associated with JME.

Topics: Adolescent; Adult; Brain; Brain Mapping; Cerebrovascular Circulation; Epilepsies, Myoclonic; Female; Humans; Male; Regional Blood Flow; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Recent data indicate that melatonin inhibits brain glutamate receptors and nitric oxide production, thus suggesting that it may exert a neuroprotective and antiexcitotoxic effect. Melatonin has been seen to prevent seizures in several animal models and to decrease epileptic manifestations in humans. The lack of response to conventional anticonvulsants in an epileptic child led us to use melatonin in this case. A female child who began to have convulsive seizures at the age of 1.5 months and was diagnosed as having severe myoclonic epilepsy was unsuccessfully treated with different combinations of anticonvulsants, including valproic acid, phenobarbital, clonazepam, vigabatrin, lamotrigin, and clobazam. Melatonin was thus added to the treatment. Imaging studies (CT, SPECT, and MNR), EEG recordings, blood biochemical, and hematological analyses, including measures of the circadian rhythm of melatonin, were made. The child was initially treated with various anticonvulsants. Severe neurological and psychomotor deterioration combined with increased seizure activity showed a lack of response to the treatment. At the age of 29 mon the patient was in a pre-comatose stage at which time melatonin was added to treatment. After 1 month of melatonin plus phenobarbital therapy and for a year thereafter, the child's seizures were under control. On reducing the melatonin dose after this time, however, seizures resumed and the patient's condition was re-stabilized after restoring melatonin. Prior to our attempts to reduce melatonin, all analyses, including EEG recordings and SPECT, were normal. As far as the results of neurological examination are concerned, only mild hypotony without focalization remained. Changes in the therapeutic schedules during the second year of melatonin treatment, including the withdrawal of phenobarbital, did not result in the same degree of seizure control, although progressively the child became satisfactorily controlled. At the present moment the child continues to have mild hypotony and shows attention disorder and irritability. Melatonin has proven to be useful as adjunctive therapy in the clinical control of this case of severe infantile myoclonic epilepsy. The results suggest that melatonin may have a useful role in mechanisms of neuroprotection and also indicate its use in other cases of untreatable epilepsy. Further studies using more patients and placebo-treatment would be beneficial in understanding the potential use of melatonin as a

Topics: Anticonvulsants; Antioxidants; Brain; Chemotherapy, Adjuvant; Circadian Rhythm; Electroencephalography; Epilepsies, Myoclonic; Female; Humans; Infant; Magnetic Resonance Imaging; Melatonin; Phenobarbital; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, X-Ray Computed

The proper localization of regions of interest (ROIs) in Single Photon Emission Computed Tomography (SPECT) is an essential task. The limited spatial resolution makes it difficult to define regions by their structure. The particular problems are: 1) the difficulty to find the appropriate slice and its orientation in space; 2) the individual variation of the brain in dimension and shape. Referring to the basic work of Talairach and Szikla (1967), research is conducted to overcome these methodical problems in interpreting cranial computed tomography by using a proportional localization system. We analyzed four cases with focal motor seizures of different aetiology (tumour, hemorrhagic infarction, intracerebral hematoma, multifocal leukencephalopathy) by 99mTc HMPAO SPECT. The accumulation of the radiopharmacon was measured in ROIs which were delineated with the aid of the above mentioned system. The regions were selected in accordance to the autoradiographic study of penicillin induced epileptic seizures in animal experiments. Dependent on the severity of the clinical manifestation we were able to document the involvement of the supposed primary focus and of several related zones. We suggest that this approach should prove some usefulness in the examination of the interdependency of different brain areas.

Topics: Adult; Aged; Brain; Brain Mapping; Cerebral Cortex; Dominance, Cerebral; Epilepsies, Myoclonic; Epilepsy, Complex Partial; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Organotechnetium Compounds; Oximes; Regional Blood Flow; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon