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Metabolic Correlates of the Ictal-Interictal Continuum: FDG-PET During Continuous EEG

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Abstract

Background

Ictal-interictal continuum (IIC) continuous EEG (cEEG) patterns including periodic discharges and rhythmic delta activity are associated with poor outcome and in the appropriate clinical context, IIC patterns may represent “electroclinical” status epilepticus (SE). To clarify the significance of IIC patterns and their relationship to “electrographic” SE, we investigated FDG-PET imaging as a complementary metabolic biomarker of SE among patients with IIC patterns.

Methods

A single-center prospective clinical database was ascertained for patients undergoing FDG-PET during cEEG. Following MRI-PET co-registration, the maximum standardized uptake value in cortical and subcortical regions was compared to contralateral homologous and cerebellar regions. Consensus cEEG review and clinical rating of etiology and treatment response were performed retrospectively with blinding. Electrographic SE was classified as discrete seizures without interictal recovery or >3-Hz rhythmic IIC patterns. Electroclinical SE was classified as IIC patterns with electrographic and clinical response to anticonvulsants; clonic activity; or persistent post-ictal encephalopathy.

Results

Eighteen hospitalized subjects underwent FDG-PET during contemporaneous IIC patterns attributed to structural lesions (44 %), neuroinflammatory/neuroinfectious disease (39 %), or epilepsy (11 %). FDG-PET hypermetabolism was common (61 %) and predicted electrographic or electroclinical SE (sensitivity 79 % [95 % CI 53–93 %] and specificity 100 % [95 % CI 51–100 %]; p = 0.01). Excluding electrographic SE, hypermetabolism also predicted electroclinical SE (sensitivity 80 % [95 % CI 44–94 %] and specificity 100 % [95 % CI 51–100 %]; p = 0.01).

Conclusions

In hospitalized patients with IIC EEG patterns, FDG-PET hypermetabolism is common and is a candidate metabolic biomarker of electrographic SE or electroclinical SE.

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Authors and Affiliations

  1. Department of Neurology, Massachusetts General Hospital (MGH), 55 Fruit Street, Wang 735, Boston, MA, 02114, USA

    Aaron F. Struck, M. Brandon Westover, Gina M. Deck, Andrew J. Cole & Eric S. Rosenthal

  2. Department of Radiology, University of Wisconsin, Madison, WI, USA

    Lance T. Hall

Authors
  1. Aaron F. Struck
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  2. M. Brandon Westover
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  3. Lance T. Hall
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  4. Gina M. Deck
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  5. Andrew J. Cole
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  6. Eric S. Rosenthal
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Correspondence to Aaron F. Struck.

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Disclosures

Aaron F Struck, MD: Dr. Struck reports no disclosures. M. Brandon Westover, MD PhD: Dr. Westover receives funding from NIH-NINDS (K23 NS090900), the Rappaport Foundation, and the Andrew David Heitman Neuroendovascular Research Fund. Lance Hall, MD: receives research funding from, R01 CA158800-01 (NIH/NCI), R21 CA198392-01 (NIH/NCI), Merck/GE Healthcare. Gina M Deck, MD: Dr. Deck reports no disclosures. Andrew J Cole, MD: Dr. Cole reports no disclosures. Eric S. Rosenthal, MD: Dr. Rosenthal receives research support from an institutional contract with SAGE Therapeutics, and Grant funding from the Andrew David Heitman Neuroendovascular Research Foundation, NIBIB (5U54EB007954-04), NINDS (5U10NS080369-02), and the U.S. Army Medical Research and Materiel Command (W81XWH-08-2-0154).

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Struck, A.F., Westover, M.B., Hall, L.T. et al. Metabolic Correlates of the Ictal-Interictal Continuum: FDG-PET During Continuous EEG. Neurocrit Care 24, 324–331 (2016). https://doi.org/10.1007/s12028-016-0245-y

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  • DOI: https://doi.org/10.1007/s12028-016-0245-y

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