Patterns of postictal cerebral perfusion in idiopathic generalized epilepsy: a multi-delay multi-parametric arterial spin labelling perfusion MRI study

Guangxiang Chen,Jiechuan Ren,Xueling Suo,Du Lei,Qiyong Gong,Panli Zuo,Dong Zhou,Danny J J Wang,Meiyun Wang

doi:10.1038/srep28867

Abstract

The cerebral haemodynamic status of idiopathic generalized epilepsy (IGE) is a very complicated process. Little attention has been paid to cerebral blood flow (CBF) alterations in IGE detected by arterial spin labelling (ASL) perfusion magnetic resonance imaging (MRI). However, the selection of an optimal delay time is difficult for single-delay ASL. Multi-delay multi-parametric ASL perfusion MRI overcomes the limitations of single-delay ASL. We applied multi-delay multi-parametric ASL perfusion MRI to investigate the patterns of postictal cerebral perfusion in IGE patients with absence seizures. A total of 21 IGE patients with absence seizures and 24 healthy control subjects were enrolled. IGE patients exhibited prolonged arterial transit time (ATT) in the left superior temporal gyrus. The mean CBF of IGE patients was significantly increased in the left middle temporal gyrus, left parahippocampal gyrus and left fusiform gyrus. Prolonged ATT in the left superior temporal gyrus was negatively correlated with the age at onset in IGE patients. This study demonstrated that cortical dysfunction in the temporal lobe and fusiform gyrus may be related to epileptic activity in IGE patients with absence seizures. This information can play an important role in elucidating the pathophysiological mechanism of IGE from a cerebral haemodynamic perspective.

Highlights

Period and hypoperfusion during the interictal period[7,8,12,13]
The cerebral perfusion patterns of Idiopathic generalized epilepsy (IGE) patients have largely been derived from these studies using PET21 or single photon emission computed tomography (SPECT)[22,23,24,25], and little attention has been paid to the cerebral blood alterations detected by ASL perfusion magnetic resonance imaging (MRI) in IGE patients
We identified postictal cerebral perfusion alterations in IGE patients with absence seizures relative to healthy control subjects using multi-delay multi-parametric ASL perfusion MRI

Summary

Introduction

Period and hypoperfusion during the interictal period[7,8,12,13]. ASL has a very good concordance with fluorodeoxyglucose positron emission tomography (FDG-PET) and a moderate concordance with video-EEG monitoring[8,14]. A SPECT study reported that CBF is diffusely reduced throughout the brain during the occurrence of typical absence seizure, whereas CBF increases during the postictal phase[27] Another SPECT study in patients with juvenile myoclonic epilepsy during the interictal period demonstrated a significant regional CBF reduction in bilateral thalami, cerebelli and the brainstem, whereas regional CBF increased in the left superior frontal gyrus[25]. The purpose of the present study was to conduct an exploratory study for characterizing the patterns of postictal cerebral perfusion in IGE patients with absence seizures using multi-delay multi-parametric ASL perfusion MRI to: (1) investigate whether there are significant differences in the parameters of ATT and CBF using voxel-based whole brain analysis between these patients and healthy control subjects, and (2) evaluate the relationships between these identified neuroimaging findings and illness duration, as well as the age at onset

Objectives

Methods

Results

Conclusion