Ictal Functional Neuroimaging of Childhood Absence Epilepsy

ICTAL FUNCTIONAL NEUROIMAGING OF CHILDHOOD ABSENCE EPILEPSY Matthew Vestal (Sponsored by Hal Blumenfeld). Departments of Neurology, Neurobiology, and Neurosurgery, Yale University School of Medicine, New Haven, CT. Absence seizures in Childhood Absence Epilepsy (CAE) are 5 – 10 second episodes of impaired consciousness that are characterized on electroencephalography (EEG) by frontally-predominant, 3 – 4 Hz spike and wave discharges (SWD). The aims of this study were to use simultaneous EEG, functional magnetic resonance imaging (fMRI), and behavioral testing to identify the neural networks involved in absence seizures as well as to examine the timecourse of those ictal fMRI changes. It was hypothesized that absence seizures involve wide-reaching neural networks including the areas traditionally associated with normal attention processing and that absence seizures produce fMRI signal changes not only during the seizure, but before and after it as well. In this study, we recorded 88 absence seizures from a cohort of 42 children with pure CAE. These seizures were recorded as subjects participated in simultaneous EEG-fMRI scanning while engaged in a continuous performance task (CPT) of attentional vigilance or a repetitive tapping task (RTT) requiring repetitive motor activity. Using a novel, voxelbased percent fMRI change analysis combined with a volume of interest analysis, the second-by-second fMRI signal timecourse of the absence seizures were examined across numerous brain regions of interest, from 20 seconds before seizure onset through 40 seconds after seizure onset. EEG frequency analysis revealed seizures with a mean duration of 6.6 seconds and an abrupt onset and ending that were comprised of frontallypredominant, 3 – 4 Hz SWD. Ictal behavioral testing demonstrated abrupt onset of impairments during periods of SWD. These behavioral impairments were typical of CAE absence seizures in that impairments were greater in the CPT of attentional vigilance (omission error rate, OER = 81%) than in RTT testing (OER = 39 %) (p < 0.003). The ictal fMRI changes we observed varied depending upon the method of fMRI signal analysis used. Using the traditional general liner model, and assuming the standard hemodynamic response (HRF) function, this study replicated results consistent with previous ictal absence fMRI studies – showing ictal activations primarily in the thalamus and ictal deactivations in traditional ‘default mode’ areas. Using a more data-driven,