Brain, Vol 121, Issue 7 1295-1304, Copyright © 1998 by Oxford University Press
MP Richardson, MJ Koepp, DJ Brooks, JT Coull, P Grasby, DR Fish and JS Duncan
Malformations of cortical development (MCD) are an important aetiology of
localization-related epilepsy. Previous MRI and [11C]flumazenil PET studies
have demonstrated widespread structural and neuroreceptor abnormalities
beyond the region of MCD that is visually apparent on MRI. We investigated
the ability of brain regions affected by MCD to participate in normal
cognitive and motor tasks and compared the responses seen in such patients
with those in normal subjects. We studied five patients known to have MCD
affecting the occipital region and seven normal subjects using H2 (15)O PET
whilst they were performing a visual attention task. We also studied five
right-handed patients known to have MCD affecting the left frontal lobe and
seven right-handed normal subjects, using H2 (15)O PET whilst they were
performing a motor learning task with the right hand. The patient and
normal control data were examined using statistical parametric mapping to
determine the ability of the brain region affected by MCD to participate in
the task and also to detect evidence for atypical organization of cortical
function in association with the MCD. Eight of the ten patients with MCD
showed significant alteration of relative regional cerebral blood flow
during the task compared with 'rest' in the affected brain region. These
regions included focally dysgenetic cortex, the cortex lining
schizencephalic clefts, heterotopic bands, subependymal grey matter
heterotopia, and the cortex overlying band and subependymal heterotopia. In
addition there was a significant alteration in the overall activation
pattern in five patients compared with the normal control groups; in all
five patients this atypical organization involved regions of cortex that
appeared entirely normal on MRI. We conclude that regions of MCD may
participate in normal cognitive functions but widespread cortical atypical
organization may be seen. These findings have implications for surgical
planning in any such patients.
ARTICLES
Cerebral activation in malformations of cortical development
Epilepsy Research Group, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
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