Perfusion network shift during seizures in medial temporal lobe epilepsy

Medial temporal lobe epilepsy (MTLE) is associated with limbic atrophy involving the hippocampus, peri-hippocampal and extra-temporal structures. While MTLE is related to static structural limbic compromise, it is unknown whether the limbic system undergoes dynamic regional perfusion network alterat...

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Bibliographic Details
Published in:	PloS one Vol. 8; no. 1; p. e53204
Main Authors:	Sequeira, Karen M, Tabesh, Ali, Sainju, Rup K, DeSantis, Stacia M, Naselaris, Thomas, Joseph, Jane E, Ahlman, Mark A, Spicer, Kenneth M, Glazier, Steve S, Edwards, Jonathan C, Bonilha, Leonardo
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 14-01-2013 Public Library of Science (PLoS)
Subjects:	Adult Atrophy Biology Brain CAT scans Cerebellum Child Child, Preschool Computed tomography Correlation Cortex (temporal) Demography EEG Electroencephalography Emission analysis Epilepsy Epilepsy, Temporal Lobe - complications Epilepsy, Temporal Lobe - diagnostic imaging Epilepsy, Temporal Lobe - pathology Epilepsy, Temporal Lobe - physiopathology Functional morphology Hippocampus Humans Infant Infusion Intravenous administration Intravenous infusion Limbic system Medical imaging Medical imaging equipment Medical research Medicine Metabolic networks Metabolism Middle Aged Nerve Net - diagnostic imaging Nerve Net - pathology Nerve Net - physiopathology Neurology Neurosciences NMR Nuclear magnetic resonance Patients Perfusion Photon emission Putamen Radioactive tracers Radiology Radionuclide Imaging Seizing Seizures Seizures (Medicine) Seizures - complications Seizures - diagnostic imaging Seizures - pathology Seizures - physiopathology Single photon emission computed tomography Technetium Technetium Tc 99m Exametazime Temporal lobe Temporal lobe epilepsy Thalamus Tracers (Biology) Young Adult United States > US South Carolina
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Summary:	Medial temporal lobe epilepsy (MTLE) is associated with limbic atrophy involving the hippocampus, peri-hippocampal and extra-temporal structures. While MTLE is related to static structural limbic compromise, it is unknown whether the limbic system undergoes dynamic regional perfusion network alterations during seizures. In this study, we aimed to investigate state specific (i.e. ictal versus interictal) perfusional limbic networks in patients with MTLE. We studied clinical information and single photon emission computed tomography (SPECT) images obtained with intravenous infusion of the radioactive tracer Technetium- Tc 99 m Hexamethylpropyleneamine Oxime (Tc-99 m HMPAO) during ictal and interictal state confirmed by video-electroencephalography (VEEG) in 20 patients with unilateral MTLE (12 left and 8 right MTLE). Pair-wise voxel-based analyses were used to define global changes in tracer between states. Regional tracer uptake was calculated and state specific adjacency matrices were constructed based on regional correlation of uptake across subjects. Graph theoretical measures were applied to investigate global and regional state specific network reconfigurations. A significant increase in tracer uptake was observed during the ictal state in the medial temporal region, cerebellum, thalamus, insula and putamen. From network analyses, we observed a relative decreased correlation between the epileptogenic temporal region and remaining cortex during the interictal state, followed by a surge of cross-correlated perfusion in epileptogenic temporal-limbic structures during a seizure, corresponding to local network integration. These results suggest that MTLE is associated with a state specific perfusion and possibly functional organization consisting of a surge of limbic cross-correlated tracer uptake during a seizure, with a relative disconnection of the epileptogenic temporal lobe in the interictal period. This pattern of state specific shift in metabolic networks in MTLE may improve the understanding of epileptogenesis and neuropsychological impairments associated with MTLE.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Conceived and designed the experiments: KMS AT RKS SD TN JEJ JCE LB. Performed the experiments: KMS LB. Analyzed the data: KMS LB. Contributed reagents/materials/analysis tools: KMS MA SG JCE. Wrote the paper: KMS LB. Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0053204