ILAE neuroimaging task force highlight: Subcortical laminar heterotopia

The ILAE Neuroimaging Task Force publishes educational case reports that highlight basic aspects of neuroimaging in epilepsy consistent with the ILAE's educational mission. Subcortical laminar heterotopia, also known as subcortical band heterotopia (SBH) or "double cortex," is an intriguing and rare congenital malformation of cortical development. SBH lesions are part of a continuum best designated as agyria-pachygyria-band-spectrum. The malformation is associated with epilepsy that is often refractory, as well as variable degrees of developmental delay. Moreover, in an increasing proportion of cases, a distinct molecular-genetic background can be found. Diagnosing SBH can be a major challenge for many reasons, including more subtle lesions, and "non-classic" or unusual MRI-appearances. By presenting an illustrative case, we address the challenges and needs of diagnosing and treating SBH patients in epilepsy, especially the value of high-resolution imaging and specialized MRI-protocols.

Author Correction: Neuroimmune disorders of the central nervous system in children in the molecular era

In the original version of this Review published online and in print, the contribution of attendees of the International Neuroimmune Meeting to the content of the Review was not acknowledged. The author list has been corrected in the PDF and HTML versions of this article to acknowledge that the Review was written on behalf of attendees of the International Neuroimmune Meeting, and the names of the attendees have been added to the HTML version.

Fluency patterns in narratives from children with localization related epilepsy

This study assessed the relationship between fluency and language demand in children with epilepsy, a group known to demonstrate depressed language skills. Disfluency type and frequencies were analyzed in elicited narratives from 52 children. Half of these children had localization-related epilepsy (CWE), while the others were age- and gender-matched typically-developing (TD) peers. CWE were found to be significantly more disfluent overall than their matched TD peers during narrative productions, and demonstrated a higher proportion of stutter-like disfluencies, particularly prolongations. The current study adds to an emerging literature that has found depressed language skills and listener perceptions of verbal ability in children with chronic seizure activity, and contributes to the small but growing literature that suggests that disfluency during spoken language tasks may be a subtle marker of expressive language impairment.

EDUCATIONAL OBJECTIVES

The reader will be able to (a) describe why children with epilepsy might be at greater risk for language delays and or increased levels of disfluency; (b) describe profiles of fluency that differentiated children with chronic and recent-onset epilepsy from their age and gender matched peers; and (c) apply this information to monitoring of children with seizure disorder on their caseloads.

The effect of naloxone on cerebral blood flow and glucose metabolism in patients with complex partial seizures

We used positron emission tomography with [15O]water and [18F]fluoro-2-deoxyglucose (FDG) to study the effect of naloxone on cerebral blood flow (CBF) and glucose metabolism (LCMRglc) in patients with complex partial seizures. There was no effect on glucose metabolism, but blood flow was reduced 7-12% 45-60 min after infusion of 1 mg/kg naloxone, as was the degree of lateral temporal CBF asymmetry in patients with > 10% baseline hypoperfusion. Endogenous opiates are involved in regulation of human CBF, and possibly in hypoperfusion in epileptic foci. Since [18F]FDG PET measures mean LCMRglc over the tracer uptake and scanning periods, it is inferior to [15O]H2O PET for detecting drug effects which may be time dependent.