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P152 Detection of nocturnal frontal lobe seizures in pediatric patients by means of accelerometers: preliminary results
Posters Results: Postoperatively, 31 children achieved seizure freedom (79%). Contralateral MRI abnormalities were significantly associated with seizure recurrence; 57% of the seven patients with MRI abnormalities had recurrence (p = 0.022). Contralateral interictal epileptic EEG abnormalities (n = 23) tended to correlate with seizure recurrence (p = 0.066). Contralateral EEG and MRI abnormalities were not associated with postoperative IQ or with the change in post- versus preoperative IQ. Children, younger at epilepsy onset and with shorter duration of preoperative epilepsy had lower IQ scores (p = 0.008 and p = 0.003). Contralateral background slowing was associated with behavioural problems that occurred in eight children postoperatively (p = 0.019). Patients with postoperative behavioural problems were older at epilepsy onset (p = 0.003) and at surgery (p = 0.001). Conclusion: Contralateral MRI abnormalities increase the risk for seizure recurrence after hemispherectomy. Epileptic EEG abnormalities in the healthy hemisphere are marginally associated with seizure recurrence. Slow background activity was associated with postoperative behavioural problems. Contralateral MRI and EEG findings did not correlate with cognitive outcome. P151 In vivo 1H-[13C] MRS: A comprehensive tool to investigate the metabolic basis of brain function and disease P. van Eijsden1 *, K.L. Behar3 , G. Mason3 , K.P.J. Braun1 , R.A. de Graaf2 . 1 Child Neurology, University Medical Center Utrecht, The Netherlands; 2 Radiology, Yale University School of Medicine, New Haven, Connecticut, USA; 3 Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA Objective: 1H-[13C] MRS enables the quantification of many neurochemicals and their turnover, providing a means to study the metabolic basis of brain function and disease. It detects brain metabolites and the rate at which they are labeled by a 13C enriched precursor. TCA cycle rates and glutamatergic neurotransmission were previously successfully probed. We aim to investigate whether GABAergic neurotransmission can also be reliably measured. Methods: Wistar rats were anesthetized and placed in a 9.4T MR scanner. A femoral vein was cannulated for infusion of uniformly labeled glucose or [2−13C]-Acetate (5 vs 5 animals). Localized 1H NMR spectra were obtained in a volume of 6x5x6 mm during 13C editing. 1H-[13C] NMR signals were obtained by subtracting 13C-inverted spectra from the noninverted ones. The total metabolite concentrations and 13C fractions were quantified with LCModel with a time resolution of 16 min to obtain the localized concentration of a large array of neurochemicals and the time courses of 13C incorporation. Results: The LCModel analysis provided metabolite concentrations that are consistent with ex vivo data. Reliable turnover curves could be reconstructed for [4−13C]Glutamate, [4−13C]-Glutamine, [3−13C]-Glutamate, [3−13C]Glutamine, [2−13C]-GABA and [4−13C]-GABA. A model comprised of a glutamatergic, GABAergic and astrocytic compartment allowed for separate quantification of glutamaterig, GABAergic and astrocytic TCA cycle flux and the ´ glutamatergic and GABAergic neurotransmitter flux. Conclusion: This study shows that 1H-[13C] MRS in the rat allows for the quantification of GABAergic metabolism in the live rat, in addition to glutamaergic neurotransmission and TCA cyling rates. It is a vast improvement compared to ex vivo research and application in humans lies within the relam of possibilities. It can be used to investigate normal brain metabolism and function, but also the metabolic basis of disease. We have applied this technique in epileptogenesis in the rat and preliminary results are promising.
S67 P152 Detection of nocturnal frontal lobe seizures in pediatric patients by means of accelerometers: preliminary results B. Ceulemans1,2 *, K. Cuppens4 , L. Lagae2,3 , S. Van Huffel5 , B. Vanrumste4,5 . 1 Child Neurology, University Hospital Antwerp, Edegem, Belgium; 2 Child Neurology, Epilepsy Center, Pulderbos, Belgium; 3 Child Neurology, University Hospital Gasthuisberg, Leuven, Belgium; 4 Mobilab, KH Kempen University College, Geel, Belgium; 5 Electrical Engineering (ESAT), KU Leuven, University, Leuven, Belgium Objective: There is a great demand from parents and care-givers for an automatic reliable detecting system for nocturnal seizures in children. Until now no such detection system is available on the market. The ‘gold standard’ for the detection of an epileptic seizure still is video/EEG-monitoring. Auditory systems are mostly used in home situations. Methods: To develop a detection system for nocturnal motoric seizures, and differentiate them from normal sleep movements, by means of accelerometers attached to the wrists and ankles of a child during sleep. Simultaneously with a diagnostic video/EEG-registration the signals from three axis accelerometers attached to the wrists and ankles were co-registrated. Afterwards all nocturnal motor events were analysed and differentiated into normal and epileptic phenomena. Results: The first primary results from three paediatric patients with nocturnal frontal lobe seizures with clearly marked motor manifestations are described. A total of 24 seizures can be differentiated from 1112 normal nocturnal movements in terms of duration and intensity of the movements. Based on these data a detection algorithm is calculated for this specific type of frontal of seizures. A sensitivity of 91.67% and a specificity of 83.92% is reached. Conclusions: In three paediatric patients with frequent nocturnal frontal lobe seizures a detection system based on three axis accelerometers attached to the wrists and ankles is reliable. This is the first step in the developing of a reliable detection system for nocturnal motor seizures in children. P153 Neuroimaging findings in children with recurrent headaches: experience from a developing country M. Ray1 *, M. Sood1 , P. Kumar1 , N. Khandelwal2 , P. Singhi1 . 1 Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India; 2 Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India Introduction: Recurrent headaches in children are common and a cause of concern. Studies from the West have shown that neuroimaging in such children offers little diagnostic yield.1−4 There is lack of information about the situation in the developing world where infective CNS illnesses are prevalent. Objective: To assess the utility of neuroimaging findings in children suffering from recurrent headaches. Materials and Methods: 160 children with recurrent headaches were examined clinically, investigated and classified according to revised IHS criteria 2004 and by followed up using prospective headache diaries. Results: The mean age was 11.3±2.1 years and 52.4% were boys and mean duration of headache prior to enrolment was 15.8±12.5 months (range 4−96 months). Majority of cases were diagnosed to have migraine (72%), tension type headache (25%) and unclassified (3%). Neuroimaging was performed in 85 children of whom 30 were done prior to hospital referral. The brain imaging studies were performed because of recent change in headache pattern and parental concerns. Benign neuroimaging abnormalities were seen in
S67 P152 Detection of nocturnal frontal lobe seizures in pediatric patients by means of accelerometers: preliminary results B. Ceulemans1,2 *, K. Cuppens4 , L. Lagae2,3 , S. Van Huffel5 , B. Vanrumste4,5 . 1 Child Neurology, University Hospital Antwerp, Edegem, Belgium; 2 Child Neurology, Epilepsy Center, Pulderbos, Belgium; 3 Child Neurology, University Hospital Gasthuisberg, Leuven, Belgium; 4 Mobilab, KH Kempen University College, Geel, Belgium; 5 Electrical Engineering (ESAT), KU Leuven, University, Leuven, Belgium Objective: There is a great demand from parents and care-givers for an automatic reliable detecting system for nocturnal seizures in children. Until now no such detection system is available on the market. The ‘gold standard’ for the detection of an epileptic seizure still is video/EEG-monitoring. Auditory systems are mostly used in home situations. Methods: To develop a detection system for nocturnal motoric seizures, and differentiate them from normal sleep movements, by means of accelerometers attached to the wrists and ankles of a child during sleep. Simultaneously with a diagnostic video/EEG-registration the signals from three axis accelerometers attached to the wrists and ankles were co-registrated. Afterwards all nocturnal motor events were analysed and differentiated into normal and epileptic phenomena. Results: The first primary results from three paediatric patients with nocturnal frontal lobe seizures with clearly marked motor manifestations are described. A total of 24 seizures can be differentiated from 1112 normal nocturnal movements in terms of duration and intensity of the movements. Based on these data a detection algorithm is calculated for this specific type of frontal of seizures. A sensitivity of 91.67% and a specificity of 83.92% is reached. Conclusions: In three paediatric patients with frequent nocturnal frontal lobe seizures a detection system based on three axis accelerometers attached to the wrists and ankles is reliable. This is the first step in the developing of a reliable detection system for nocturnal motor seizures in children. P153 Neuroimaging findings in children with recurrent headaches: experience from a developing country M. Ray1 *, M. Sood1 , P. Kumar1 , N. Khandelwal2 , P. Singhi1 . 1 Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India; 2 Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India Introduction: Recurrent headaches in children are common and a cause of concern. Studies from the West have shown that neuroimaging in such children offers little diagnostic yield.1−4 There is lack of information about the situation in the developing world where infective CNS illnesses are prevalent. Objective: To assess the utility of neuroimaging findings in children suffering from recurrent headaches. Materials and Methods: 160 children with recurrent headaches were examined clinically, investigated and classified according to revised IHS criteria 2004 and by followed up using prospective headache diaries. Results: The mean age was 11.3±2.1 years and 52.4% were boys and mean duration of headache prior to enrolment was 15.8±12.5 months (range 4−96 months). Majority of cases were diagnosed to have migraine (72%), tension type headache (25%) and unclassified (3%). Neuroimaging was performed in 85 children of whom 30 were done prior to hospital referral. The brain imaging studies were performed because of recent change in headache pattern and parental concerns. Benign neuroimaging abnormalities were seen in