Regional cerebral blood flow during seizures in neonates☆,☆☆,★,★★
Section snippets
Patients and Methods
Ictal studies were performed in 12 mature infants with recurrent seizures (Table).The clinical seizures were classified according to Volpe.3
A reference group was made up of interictal studies of six of these infants and studies of three asphyxiated infants. All of these infants had continuous electroencephalography without electrical or clinical seizures at the time of examination, and results of a brain ultrasonographic scan were normal.
Methods
We used a brain dedicated fast-rotating four-head multidetector system specially designed for neonatal studies (Tomomatic 248, Medimatic, Denmark) and 99mTc-D, L,-hexamethylpropylenamine oxime in a dose of 4 MBq/kg.2
In ictal studies the tracer was injected within 10 seconds after the onset of the seizure. Images were normalized to the mean of the hemispheres, and the slices were transformed to a standard position and a standard size, an ellipse with axes of 100 mm and 120 mm. A set of mean and
Results
During the ictal and interictal studies pCO2, pO2, arterial oxygen saturation, and mean blood pressure did not differ significantly. The interictal global CBF was 19.9 ml/100 gm/min (95% CI 16.0-23.8 ml/100 gm/min).
As determined by visual inspection of the Z-score images, seven (58%) infants had convincing ARIFs (Fig. 1), three (25%) had presumed ARIFs, and two had no ARIFs.
Discussion
This study provides new evidence that the immature brain of the newborn has the capability of focally increasing the CBF and metabolism during seizures and confirms the results of a study of a single infant with focal seizures examined ictally by positron emission tomography.6 Ictal increase of rCBF was demonstrated in both clinical and subclinical seizures. The method yields only relative values of rCBF. However, with a reference group we may estimate the ictal increase in rCBF and perform
Acknowledgements
The support from Professor Niels A. Lassen, Department of Clinical Physiology, Bispebjerg Hospital, Copenhagen, Denmark, and Professor Olaf B. Paulson, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark, is greatly appreciated.
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Cited by (24)
Neonatal Seizures
2018, Volpe's Neurology of the NewbornNeonates with Seizures: What to Consider, How to Image
2011, Magnetic Resonance Imaging Clinics of North AmericaCitation Excerpt :However, there is currently no available literature addressing the epileptic neonate. Single-photon emission CT (SPECT) with technetium-99m-hexamethylpropyleneamine (99mTc-HmPAO) is widely used in neonatal seizures.43,44 SPECT relies on increased perfusion during the ictal period to detect an active epileptic focus.
Heme oxygenase inhibition reduces neuronal activation evoked by bicuculline in newborn pigs
2004, Brain ResearchCitation Excerpt :The experimental bicuculline model of sustained generalized seizures is widely accepted for study of the pathophysiology of epilepsy. Bicuculline-induced experimental seizures have much similarity with the seizures recorded in human neonates [3]. In newborn pigs, great increases in mean values of the EEG amplitude and spectral powers in seven bands within a 1–15-Hz frequency range were observed immediately (in <1 min) after bicuculline administration, and these changes were sustained for the 120-min observation period.
Neonatal Seizures
2017, Volpe's Neurology of the NewbornIctal SPECT is useful in localizing the epileptogenic zone in infants with cortical dysplasia
2016, Epileptic DisordersCerebral vascular regulation and brain injury in preterm infants
2014, American Journal of Physiology - Regulatory Integrative and Comparative Physiology
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From the Department of Neonatology and the Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark; and The John F. Kennedy Institute, Glostrup, Denmark.
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Supported by The A.P. Møller and Chastine McKinney Møller Foundation.
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Reprint requests: Klaus Børch, MD, PhD, Department of Neonatology 5024, Copenhagen University Hospital, Rigshospitalet, Blegdamsuej, 9, DK-2100 Copenhagen, Denmark.
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0022-3476/98/$5.00 + 0 9/21/83075