Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Neurocritical Care
Published in: Neurocritical Care 3/2016

01-06-2016 | Original Article

Metabolic Correlates of the Ictal-Interictal Continuum: FDG-PET During Continuous EEG

Authors: Aaron F. Struck, M. Brandon Westover, Lance T. Hall, Gina M. Deck, Andrew J. Cole, Eric S. Rosenthal

Published in: Neurocritical Care | Issue 3/2016

Login to get access

Abstract

Background

Ictal-interictal continuum (IIC) continuous EEG (cEEG) patterns including periodic discharges and rhythmic delta activity are associated with poor outcome and in the appropriate clinical context, IIC patterns may represent “electroclinical” status epilepticus (SE). To clarify the significance of IIC patterns and their relationship to “electrographic” SE, we investigated FDG-PET imaging as a complementary metabolic biomarker of SE among patients with IIC patterns.

Methods

A single-center prospective clinical database was ascertained for patients undergoing FDG-PET during cEEG. Following MRI-PET co-registration, the maximum standardized uptake value in cortical and subcortical regions was compared to contralateral homologous and cerebellar regions. Consensus cEEG review and clinical rating of etiology and treatment response were performed retrospectively with blinding. Electrographic SE was classified as discrete seizures without interictal recovery or >3-Hz rhythmic IIC patterns. Electroclinical SE was classified as IIC patterns with electrographic and clinical response to anticonvulsants; clonic activity; or persistent post-ictal encephalopathy.

Results

Eighteen hospitalized subjects underwent FDG-PET during contemporaneous IIC patterns attributed to structural lesions (44 %), neuroinflammatory/neuroinfectious disease (39 %), or epilepsy (11 %). FDG-PET hypermetabolism was common (61 %) and predicted electrographic or electroclinical SE (sensitivity 79 % [95 % CI 53–93 %] and specificity 100 % [95 % CI 51–100 %]; p = 0.01). Excluding electrographic SE, hypermetabolism also predicted electroclinical SE (sensitivity 80 % [95 % CI 44–94 %] and specificity 100 % [95 % CI 51–100 %]; p = 0.01).

Conclusions

In hospitalized patients with IIC EEG patterns, FDG-PET hypermetabolism is common and is a candidate metabolic biomarker of electrographic SE or electroclinical SE.
Literature
1.
Hirsch LJ, LaRoche SM, Gaspard N, et al. American Clinical Neurophysiology Society’s standardized critical care EEG terminology: 2012 version. J Clin Neurophysiol. 2013;30:1–27.CrossRefPubMed
2.
Orta DS, Chiappa KH, Quiroz AZ, Costello DJ, Cole AJ. Prognostic implications of periodic epileptiform discharges. Arch Neurol. 2009;66:985–91.PubMed
3.
Walsh JM, Brenner RP. Periodic lateralized epileptiform discharges–long-term outcome in adults. Epilepsia. 1987;28:533–6.CrossRefPubMed
4.
Claassen J, Jette N, Chum F, et al. Electrographic seizures and periodic discharges after intracerebral hemorrhage. Neurology. 2007;69:1356–65.CrossRefPubMed
5.
Claassen J. How I treat patients with EEG patterns on the ictal-interictal continuum in the neuro ICU. Neurocrit Care. 2009;11:437–44.CrossRefPubMed
6.
Coeytaux A, Jallon P, Galobardes B, Morabia A. Incidence of status epilepticus in French-speaking Switzerland: (EPISTAR). Neurology. 2000;55:693–7.CrossRefPubMed
7.
Knake S, Rosenow F, Vescovi M, et al. Incidence of status epilepticus in adults in Germany: a prospective, population-based study. Epilepsia. 2001;42:714–8.CrossRefPubMed
8.
Treiman DM, Walton NY, Kendrick C. A progressive sequence of electroencephalographic changes during generalized convulsive status epilepticus. Epilepsy Res. 1990;5:49–60.CrossRefPubMed
9.
Claassen J, Perotte A, Albers D, et al. Nonconvulsive seizures after subarachnoid hemorrhage: multimodal detection and outcomes. Ann Neurol. 2013;74:53–64.CrossRefPubMedPubMedCentral
10.
Hajek M, Antonini A, Leenders KL, Wieser HG. Epilepsia partialis continua studied by PET. Epilepsy Res. 1991;9:44–8.CrossRefPubMed
11.
Engel J Jr, Kuhl DE, Phelps ME. Patterns of human local cerebral glucose metabolism during epileptic seizures. Science. 1982;218:64–6.CrossRefPubMed
12.
Meltzer CC, Adelson PD, Brenner RP, et al. Planned ictal FDG PET imaging for localization of extratemporal epileptic foci. Epilepsia. 2000;41:193–200.CrossRefPubMed
13.
Stayman A, Abou-Khalil B. FDG-PET in the diagnosis of complex partial status epilepticus originating from the frontal lobe. Epilepsy Behav. 2011;20:721–4.CrossRefPubMed
14.
Siclari F, Prior JO, Rossetti AO. Ictal cerebral positron emission tomography (PET) in focal status epilepticus. Epilepsy Res. 2013;105:356–61.CrossRefPubMed
15.
Chugani HT, Shewmon DA, Khanna S, Phelps ME. Interictal and postictal focal hypermetabolism on positron emission tomography. Pediatr Neurol. 1993;9:10–5.CrossRefPubMed
16.
17.
Franck G, Sadzot B, Salmon E. et al [Study of cerebral metabolism and blood flow in partial complex epilepsy and status epilepticus in man using positron emission tomography]. Rev Electroencephalogr Neurophysiol Clin. 1986;16:199–216.CrossRefPubMed
18.
Handforth A, Cheng JT, Mandelkern MA, Treiman DM. Markedly increased mesiotemporal lobe metabolism in a case with PLEDs: further evidence that PLEDs are a manifestation of partial status epilepticus. Epilepsia. 1994;35:876–81.CrossRefPubMed
19.
Kim HY, Kim JY, Kim GU, Han HJ, Shin DI. Alien hand syndrome after epilepsia partialis continua: FDG PET and MRI studies. Epilepsy Behav. 2012;23:71–3.CrossRefPubMed
20.
Granov AM, Titutin LA, Schwarz T. Positron emission tomography. Berlin: Springer; 2008.
21.
Kinahan PE, Fletcher JW. Positron emission tomography-computed tomography standardized uptake values in clinical practice and assessing response to therapy. Semin Ultrasound CT MR. 2010;31:496–505.CrossRefPubMedPubMedCentral
22.
Hikima A, Mochizuki H, Oriuchi N, Endo K, Morikawa A. Semiquantitative analysis of interictal glucose metabolism between generalized epilepsy and localization related epilepsy. Ann Nucl Med. 2004;18:579–84.CrossRefPubMed
23.
Ng S, Villemagne VL, Berlangieri S, et al. Visual assessment versus quantitative assessment of 11C-PIB PET and 18F-FDG PET for detection of Alzheimer’s disease. J Nucl Med. 2007;48:547–52.CrossRefPubMed
24.
Chong DJ, Hirsch LJ. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. J Clin Neurophysiol. 2005;22:79–91.CrossRefPubMed
25.
Young GB, Jordan KG, Doig GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology. 1996;47:83–9.CrossRefPubMed
26.
Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med. 1998;17:857–72.CrossRefPubMed
27.
Moses WW. Fundamental limits of spatial resolution in PET. Nucl Instrum Methods Phys Res A. 2011;648(Supplement 1):S236–40.CrossRefPubMed
Metadata
Title
Metabolic Correlates of the Ictal-Interictal Continuum: FDG-PET During Continuous EEG
Authors
Aaron F. Struck
M. Brandon Westover
Lance T. Hall
Gina M. Deck
Andrew J. Cole
Eric S. Rosenthal
Publication date
01-06-2016
Publisher
Springer US
Published in
Neurocritical Care / Issue 3/2016
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-016-0245-y

Other articles of this Issue 3/2016

Neurocritical Care 3/2016 Go to the issue

Original Article

Prolonging Support After Brain Death: When Families Ask for More

Original Article

CSF Volumetric Analysis for Quantification of Cerebral Edema After Hemispheric Infarction

Translational Research

Erythropoietin Inhibits the Increase of Pulmonary Labile Zinc and the Expression of Inflammatory Mediators Following Subarachnoid Hemorrhage in Rats

Original Article

The Role of FEIBA in Reversing Novel Oral Anticoagulants in Intracerebral Hemorrhage

Practical Pearl

Devastating Delayed Leukoencephalopathy Associated with Bath Salt Inhalation

Original Article

Non-invasive Monitoring of Dynamic Cerebrovascular Autoregulation Using Near Infrared Spectroscopy and the Finometer Photoplethysmograph