Regional cerebral blood flow during seizures in neonates,☆☆,,★★

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Abstract

With the use of 99mTc-D, L,-hexamethylpropylenamine oxime and single photon emission computed tomography, regional cerebral blood flow was measured ictally in 12 mature infants with recurrent seizures and compared with a reference group of nine interictal studies. The study indicates that both clinical and electrical seizures in neonates are associated with a focal cerebral hyperperfusion of the same amount as seen in adults. (J Pediatr 1998;132:431-5)

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.

. Ictal 99mTc-HMPAO images of infant with left-sided focal seizures (patient 1) and averaged images of reference group.

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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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.

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

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