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Burneo JG, Hamilton M, Vezina W, Parrent A. Utility of Ictal SPECT in the Presurgical Evaluation of Rasmussen's Encephalitis. Can J Neurol Sci 2014; 33:107-10. [PMID: 16583733 DOI: 10.1017/s0317167100004807] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Rasmussen's encephalitis is a progressive disease characterized by severe progressive neurological and cognitive deficits. It is a difficult condition to treat with conventional medical treatment and requires, in most of the cases, surgical intervention. METHODS We present the case of a patient with Rasmussen's encephalitis who presented with epilepsia partialis continua, who did not respond to antiepileptic treatment and was evaluated for possible surgical intervention. RESULTS The electroencephalographic studies revealed bihemispheric involvement during seizures, although magnetic resonance imaging (MRI) showed a marked right hemispheric atrophy. Hyperperfusion over the right hemisphere was seen with the performance of ictal single photon emission computed tomography (SPECT), which finally guided a right functional hemispherectomy and subsequent seizure control. CONCLUSION Ictal SPECT could be a useful tool in the armamentarium of tools used for the localization of the epileptogenic focus in patients with Rasmussen's encephalitis and other localization-related epilepsies.
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Affiliation(s)
- Jorge G Burneo
- Epilepsy Programme, University of Western Ontario, London, Canada
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2
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Duchowny M, Cross JH. Preoperative evaluation in children for epilepsy surgery. HANDBOOK OF CLINICAL NEUROLOGY 2012; 108:829-839. [PMID: 22939069 DOI: 10.1016/b978-0-444-52899-5.00031-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Michael Duchowny
- University of Miami Leonard Miller School of Medicine, Miami, FL, USA.
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3
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Role of single photon emission computed tomography in epilepsy. INTERNATIONAL JOURNAL OF MOLECULAR IMAGING 2010; 2011:803920. [PMID: 21490734 PMCID: PMC3065814 DOI: 10.1155/2011/803920] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Accepted: 10/25/2010] [Indexed: 11/18/2022]
Abstract
Molecular imaging with ictal single photon emission computed tomography (SPECT) is an established functional imaging modality for the presurgical evaluation of patients with refractory partial onset seizures. SPECT coregistered on to the MRI has greater sensitivity to identify the ictal onset zone. Ictal SPECT should always be interpreted in the context of other presurgical investigations. Ictal SPECT is sensitive method for the lateralization of TLE, but ictal SPECT is more sensitive when MRI is normal. Ictal SPECT and interictal PET are complementary to each other in lateralizing the side in patients with TLE and normal MRI. In extratemporal epilepsy, ictal SPECT will guide the placement of surface grid and depth electrodes.
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Tessonnier L, Thomas P, Benisvy D, Chanalet S, Chaborel JP, Bussière F, Darcourt J. Perfusion SPECT Findings in a Suspected Case of Rasmussen Encephalitis. J Neuroimaging 2009; 19:378-80. [DOI: 10.1111/j.1552-6569.2008.00320.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bien CG, Elger CE. Neue Erkenntnis zur Rasmussen-Enzephalitis. DER NERVENARZT 2005; 76:1470, 1472-4, 1477-80, 1484-7. [PMID: 15990996 DOI: 10.1007/s00115-005-1955-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Rasmussen encephalitis (RE) is a severe and at the same time pathophysiologically fascinating condition. The chronic inflammation affects one of the two cerebral hemispheres and destroys it during the disease process that lasts from months to years. The patients -- mostly children -- suffer from frequent pharmacoresistant seizures, often in the form of epilepsia partialis continua. In parallel to the atrophy of the affected hemisphere, the neurological functions associated with it decline continuously. This results in a final stage with a usually high-grade sensorimotor hemisyndrome, hemianopia, cognitive impairment and -- if the language-dominant hemisphere is affected -- aphasia. Research results in the last 5 years have contributed to a deeper understanding of the pathogenesis of this condition. Formal diagnostic criteria have been proposed, and new therapeutic options have emerged by which the disease progression can be slowed or stopped. This article summarizes the current research results on the background of older data and gives recommendations regarding diagnostic and therapeutic procedures in RE patients.
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Affiliation(s)
- C G Bien
- Klinik für Epileptologie, Universität Bonn.
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6
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Chiapparini L, Granata T, Farina L, Ciceri E, Erbetta A, Ragona F, Freri E, Fusco L, Gobbi G, Capovilla G, Tassi L, Giordano L, Viri M, Dalla Bernardina B, Spreafico R, Savoiardo M. Diagnostic imaging in 13 cases of Rasmussen's encephalitis: can early MRI suggest the diagnosis? Neuroradiology 2003; 45:171-83. [PMID: 12684722 DOI: 10.1007/s00234-002-0923-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2002] [Accepted: 11/20/2002] [Indexed: 11/29/2022]
Abstract
Rasmussen's encephalitis (RE) is a rare, progressive, chronic encephalitis characterised by drug-resistant epilepsy, progressive hemiparesis and mental impairment. It typically involves only one cerebral hemisphere, which becomes atrophic. We present neuroradiological findings in 13 children with RE. MRI was performed in all patients, fluorodeoxyglucose positron-emission tomography (PET) in three, Tc-99m hexamethylpropylenamine oxime single-photon emission computed tomography (SPECT) in two and proton MR spectroscopy ((1)HMRS) in two. MRI showed progression of the hemisphere atrophy, always prevalent in the region primarily involved (13 patients), spread of the abnormal signal in white matter (11) and cortex (10) and progression of atrophy of the head of the caudate nucleus (nine). Associated secondary changes were: atrophy of the contralateral cerebellar hemisphere (in four patients), the ipsilateral hippocampus (in five) and the brain stem (in five). The earliest CT and MRI abnormalities, seen between 1 day and 4 months after the first seizure (in 12 patients examined, nine of whom had MRI) in one cerebral hemisphere included: high signal on T2-weighted images in the cortex (seven patients) and white matter (nine), cortical atrophy usually involving the frontoinsular region, with mild or severe enlargement of the lateral ventricle (eight) and moderate atrophy of the head of the caudate nucleus (seven). Cortical swelling in the early stage of the disease was recognisable only in two patients. PET revealed hypometabolism, SPECT decreased perfusion, and (1)HMRS reduction of N-acetylaspartate in the affected hemisphere. PET and SPECT were usually performed in the late stages and did not provide specific findings. MRI thus demonstrates the progression of RE and may suggest the diagnosis in the early stages, often before the appearance of neurological deficits. Early diagnosis of RE may be crucial for selecting patients for aggressive medical therapy or major surgical interventions such as hemispherectomy.
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Affiliation(s)
- L Chiapparini
- Department of Neuroradiology, Istituto Nazionale Neurologico C Besta, Via Celoria 11, 20133 Milano, Italy.
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Ishibashi H, Simos PG, Wheless JW, Baumgartner JE, Kim HL, Davis RN, Zhang W, Papanicolaou AC. Multimodality functional imaging evaluation in a patient with Rasmussen's encephalitis. Brain Dev 2002; 24:239-44. [PMID: 12015167 DOI: 10.1016/s0387-7604(02)00036-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Rasmussen's encephalitis (RE) is a cryptogenic progressive inflammatory disorder of the brain that causes severe neurological problems, including intractable focal epilepsy. In select patients, aggressive treatment using cerebral hemispherectomy may ameliorate the devastating cognitive decline that accompanies this disease, even if the epileptic focus appears broadly distributed. We present a case of histopathologically-confirmed RE evaluated using a multimodal process that explored the physical and functional aspects of the associated epilepsy. This process included magnetic resonance imaging, single photo emission computed tomography, electroencephalography, and magnetoencephalography (MEG). The findings indicate that functional brain imaging data may greatly assist the surgical treatment decision-making process in RE, especially when structural imaging fails to reveal definitive localizing information. In addition, MEG may provide insights about the cortical reorganization of somatosensory cortex following hemispherectomy.
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Affiliation(s)
- Hideaki Ishibashi
- Department of Neurosurgery, Vivian L Smith Center for Neurologic Research, Division of Clinical Neurosciences, The University of Texas Health Science Center at Houston, USA.
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8
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Andermann F, Hart Y. Rasmussen's syndrome, with particular reference to cerebral plasticity: a tribute to Frank Morrell. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2001; 45:173-208. [PMID: 11130899 DOI: 10.1016/s0074-7742(01)45011-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- F Andermann
- McGill University, Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada
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9
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Türkdogan-Sözüer D, Ozek MM, Sav A, Dinçer A, Pamir MN. Serial MRI and MRS studies with unusual findings in Rasmussen's encephalitis. Eur Radiol 2000; 10:962-6. [PMID: 10879711 DOI: 10.1007/s003300051045] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Rasmussen's syndrome is characterized by intractable seizures and progressive neuropsychiatric deterioration secondary to unilateral cortical inflammation and tissue destruction. Diagnosis of Rasmussen's syndrome in the early phase depends mainly on the clinical features. Neuroimaging and histopathologic examinations may not be specific during this period. We report a case of Rasmussen's syndrome followed by serial MRI and magnetic resonance spectroscopy (MRS) studies over a 3- to 16-month period. A healthy 6-year-old boy presented with focal motor seizures. An MRI study demonstrated prominent enlargement and T2 hyperintensity of the left mesial temporal lobe and perisylvian region. This early finding evolved to volume loss and later progressive atrophy of the ipsilateral hemisphere when epilepsia partialis continua occurred. Being aware of those early MRI features in a patent with increasing frequency of focal motor seizures should suggest Rasmussen's syndrome. In addition, we found prominently increased myoinositol concentration in atrophic cortex which might reflect increased gliosis in the late period of the disease.
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Affiliation(s)
- D Türkdogan-Sözüer
- Department of Pediatric Neurology, Institute of Neurological Sciences, Marmara University, Istanbul, Turkey
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Paladin F, Capovilla G, Bonazza A, Mameli R. Utility of Tc 99m HMPAO SPECT in the early diagnosis of Rasmussen's syndrome. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1998; 19:217-20. [PMID: 10933460 DOI: 10.1007/bf02427604] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neuroradiological examinations are important in the diagnosis of Rasmussen's syndrome (RS), but they frequently result normal in the early phase of the disease. We performed Tc 99m HMPAO SPECT (single photon emission computed tomography) on an 11-year, 5-month-old, right-handed girl, two months since the first seizure. SPECT showed a reduced uptake of HMPAO in the left temporal region despite normal results with magnetic resonance imaging (MRI). After six months, she developed epilepsia partialis continua, neurological signs appeared, and MRI showed cortical atrophy on the left side. SPECT seems to be a useful, inexpensive and diffuse technology able to give information in the early phases of RS useful in the prevention of serious consequences of the disease within a medical therapeutic program (ganciclovir or intravenous immunoglobulins).
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Affiliation(s)
- F Paladin
- Division of Neurology, Ospedale Ss. Giovanni e Paolo, Venezia, Italy
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Duprez TP, Grandin C, Gadisseux JF, De Volder A, Thauvoy C, Keyeux A, Evrard P. MR-monitored remitting-relapsing pattern of cortical involvement in Rasmussen syndrome: comparative evaluation of serial MR and PET/SPECT features. J Comput Assist Tomogr 1997; 21:900-4. [PMID: 9386280 DOI: 10.1097/00004728-199711000-00010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report the serial MR and PET/SPECT findings in a 2 1/2-year-old boy presenting with Rasmussen syndrome and highlight the close qualitative correlations between the results of the imaging modality and the functional isotopic techniques. The latter demonstrated a wider field of extension of the disease process. Routine MRI demonstrated its ability to detect brain changes matching the more sensitive PET and SPECT data and correlated well with the clinical evolution.
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Affiliation(s)
- T P Duprez
- Department of Medical Imaging, Universite Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Yacubian EM, Marie SK, Valério RM, Jorge CL, Yamaga L, Buchpiguel CA. Neuroimaging findings in Rasmussen's syndrome. J Neuroimaging 1997; 7:16-22. [PMID: 9038427 DOI: 10.1111/jon19977116] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Rasmussen's syndrome is a progressive childhood disease of unknown cause characterized by severe epilepsy, hemiparesis, mental deterioration, inflammation of one cerebral hemisphere, and brain atrophy. Computed tomography, single-photon emission computed tomography (SPECT), and magnetic resonance (MR) neuroimaging findings of 8 patients with pathologically confirmed Rasmussen's syndrome were evaluated retrospectively. All patients showed a predominance of the atrophy in the temporoinsular region and cerebral hemispheric alterations on MR images in a similar extension as seen on SPECT studies. Focal increase in regional cerebral blood flow was observed in the 4 patients presenting with epilepsia partialis continua at the time of hexamethylpropyleneamineoxime injection. Extensive cortical hypoperfusion was noted in the other 4 patients who received the injection during the interictal state. Cerebellar functional abnormalities were present in 6 patients, 2 of them with structural damage.
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Affiliation(s)
- E M Yacubian
- Department of Neurology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil
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Abstract
Single-photon emission computed tomography (SPECT) is being used increasingly in the investigation of children with intractable partial seizures. SPECT imaging of regional cerebral blood flow with 99mTc-hexamethylpropylene amine oxime, iodinated radiopharmaceuticals, and 133Xe typically reveals decreased cortical perfusion interictally and increased cortical perfusion ictally in the region of the epileptic focus. Studies in both adults and children indicate significantly greater sensitivity and specificity with ictal injection of radiopharmaceutical, with interictal SPECT not infrequently revealing nonlocalizing or falsely localizing information. Recent SPECT studies employing iodinated neuroreceptor ligands report altered receptor binding in the region of the epileptic focus, providing insight into the underlying neuropharmacology of partial epilepsy. SPECT has an established role in the presurgical localization of seizure foci in children with intractable partial seizures and may be a useful modality to study the functional anatomy and clinical semiology of partial seizures in childhood.
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Affiliation(s)
- A S Harvey
- Department of Neurology, Royal Children's Hospital, Melbourne, Australia
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Sperling MR. Neuroimaging in Epilepsy: Recent Developments in MR Imaging, Positron-Emission Tomography, and Single-Photon Emission Tomography. Neurol Clin 1993. [DOI: 10.1016/s0733-8619(18)30129-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Dierckx RA, Vandevivere J, Dom L, Melis K, Janssens G, Dobbeleir A, De Deyn PP. Single photon emission computed tomography using perfusion tracers in seizure disorders. Epilepsy Res 1992; 12:131-9. [PMID: 1396539 DOI: 10.1016/0920-1211(92)90033-p] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Single photon emission computed tomography (SPECT) using perfusion tracers makes it possible to estimate regional cerebral blood flow (rCBF) and, indirectly, local brain metabolism. It may be possible to detect and follow physiopathological alterations, such as may be seen in seizure disorders. The authors review the principles of and some data on perfusion SPECT in seizure disorders, stress advantages as well as major drawbacks and add their initial experience with Tc-99m hexamethylpropyleneamine oxime (HMPAO) SPECT in febrile convulsions.
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Affiliation(s)
- R A Dierckx
- Department of Nuclear Medicine, Middleheim General Hospital, Belgium
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