Early-life thalamic lesions may underlie electrical status epilepticus in sleep
MedWire News: Cerebral lesions sustained during early development, particularly those affecting the thalamus, may be a factor underlying prominent sleep-potentiated epileptiform activity (PSPEA) in children, research suggests.
"This finding may fuel further speculation that early disruption of the corticothalamic circuitry can contribute to the development of PSPEA in selected patients," say Tobias Loddenkemper (Children's Hospital Boston, Massachusetts, USA) and co-workers.
The team identified early developmental cerebral lesions on magnetic resonance imaging (MRI) in 48% of 100 children with PSPEA confirmed on electroencephalography (cases). By contrast, lesions were present in just 19.2% of 47 children who had clinical symptoms of electrical status epilepticus in sleep (ESES) but did not have PSPEA (controls).
The difference between the groups was most striking for lesions affecting the thalamus, which were present in 14.0% versus 2.1% of cases and controls.
"The impact of our findings on immediate clinical practice is that a lower threshold for performing an MRI should be considered in pediatric patients with PSPEA as they have a higher frequency of early developmental lesions," the researchers comment in Neurology.
Children with confirmed PSPEA were significantly more likely to have cerebral palsy than were controls, at 22.0% versus 1.2%. But there were no differences between the groups in terms of age (about 7 years), gender, and presence of developmental regression, language regression, clinical seizures, autism, attention deficit, and premature birth.
"The higher frequency of cerebral palsy in cases may reflect the higher frequency of early developmental lesions in this group and may be considered more as an expression of the structural lesion of the brain than an independent factor predisposing to PSPEA," says the team.
Vascular lesions were the most common type of early developmental lesion found in the children, and this was the only type of lesion that was more common in cases than controls, at 14% versus 0%. Eight of the 14 vascular lesions were ischemic, one was hemorrhagic, and the other five were indeterminate.
"Our results set the ground for future prospective studies that should follow patients with early developmental lesions and quantify the risk of developing PSPEA and ESES," conclude Loddenkemper et al.
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By Eleanor McDermid