Correlation between interictal cerebral glucose hypometabolism and IQ in children with epilepsy_Journal of Epilepsy

Authors：

 ZHAIQiongxiang ¹ , TANGZhihong ^1,2 , CHENZhihong ¹ , HAOYin ¹ , ZENGXiaolu ¹ , ZHANGYuxin ¹

1. Department of Pediatrics, Guangdong General Hospital(Guangdong Academy of Medical Sciences), Guangdong Neuroscience, Guangzhou 510080, Guangdong, China;
2. Southern Medical University, Guangzhou 510515, Guangdong, China;

Corresponding author：

ZHAIQiongxiang, Email: zhaiqiongxiang@sina.com

Keywords：

Epileptic children; IQ; ¹⁸F-FDG PET

DOI：

10.7507/2096-0247.20150036

Video：

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Objective The aim of this study was to understand the relationship between IQ and glucose metabolism in brain cells in a wide variety of epilepsy subjects. Methods The study participants were 78 children with epilepsy and 15 healthy children for comparison. All participants were administered the Chinese Wechsler Intelligence Scale for Children (C-WISC). The verbal intelligence quotient (VIQ), performance intelligence quotient (PIQ) and full scale intelligence quotient (FIQ) were compared between epileptic children and typically developing children. 78 patients underwent interictal positron emission computed tomography (PET) using 2-deoxy-2^[¹⁸F]fluoro-D-glucose (FDG) as the tracer for evaluating brain glucose metabolism. Results VIQ, PIQ and FIQ based on the C-WISC were significantly lower in epileptic children than those in the healthy comparison group (P < 0.001, P=0.001 and P < 0.001, respectively). The IQ of patients with normal metabolism, unifocal abnormal hypometabolism and multifocal abnormal hypometabolism determined by PET differed significantly. The extent of the abnormal hypometabolism was negatively correlated with the FIQ (r_s=-0.549, P < 0.001). In patients with lateralized hypometabolism based on PET, the VIQ/PIQ discrepancy (︱VIQ-PIQ︱≥15 points)scores differed significantly between the left hemisphere abnormal hypometabolism and right hemisphere abnormal hypometabolism subgroups, being negative values in the left and positive values in the right subgroups(P=0.004). Conclusions Brain metabolic abnormalities are correlated with IQ, and perfoming interictal PET along with C-WISC can better assess the extent of severity of cognitive impairment and VIQ/PIQ discrepancy.

Citation： ZHAIQiongxiang, TANGZhihong, CHENZhihong, HAOYin, ZENGXiaolu, ZHANGYuxin. Correlation between interictal cerebral glucose hypometabolism and IQ in children with epilepsy. Journal of Epilepsy, 2015, 1(3): 220-224. doi: 10.7507/2096-0247.20150036 Copy

1.	Jambaqué I, Pinabiaux C, Lassonde M. Cognitive disorders in pediatric epilepsy. Handb Clin Neurol, 2013, 111(6):691-695.
2.	Dodrill CB. Neuropsychological effects of seizures. Epilepsy Behav, 2004, 5(1):21-24.
3.	Seidenberg M, Dalin P, Bruce H, et al. Cognitive progression in epilepsy. Neuropsychol Rev, 2007, 17(4):445-454.
4.	Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies:Report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia, 2010, 51(4):676-685.
5.	潘中允. PET/CT诊断学.北京:人民卫生出版, 2000:415-416.
6.	龚耀先, 蔡太生.中国修定韦氏儿童智力量表(C-WISC)手册.长沙:湖南地图出版社, 1993.
7.	Gottlieb L, Zelko FA, Kim DS, et al. Cognitive proficiency in pediatric epilepsy. Epilepsy Behav, 2012, 23(11):146-151.
8.	Davies G, Tenesa A, Payton A, et al. Genome-wide association studies establish that human intelligence is highly heritable and polygenic. Mol Psychiatry, 2011, 16(10):996-1005.
9.	Mefford HC, Muhle H, Ostertag P, et al. Genome-wide copy number variation in epilepsy:novel susceptibility loci in idiopathic generalized and focal epilepsies. PLoS Genet, 2010, 6(5):e1000962.
10.	Berg AT, Langfitt JT, Testa FM, et al. Global cognitive function in children with epilepsy:acommunity-based study. Epilepsia, 2008, 49(10):608-614.
11.	Borden K, Burns T, O'Leary S. A comparison of children with epilepsy to an age-and IQ-matched control group on the children's memory scale. Child Neuropsychol, 2006, 12(5):165-172.
12.	Walker N, Jackson D, Dabbs K, et al. Is lower IQ in children with epilepsy due to lower parental IQ? A controlled comparison. Dev Med Child Neurol, 2013, 55(20):278-782.
13.	Terry Jones, Eugenii A, Rabiner JR. The development, past achievements, and future directions of brain PET. J Cerebral Blood Flow Metabol, 2012, 32(10):1426-1454.
14.	Kumar A, Juhasz C, Asano E, et al. Objectiv e detection of epileptic foci by ¹⁸F-FDG PET in children undergoing epilepsy surgery. J Nucl Med, 2010, 51(12):1901-1907.
15.	Kim YH, Kang HC, Kim DS, et al. Neuroimaging in identifying focal cortical dysplasia and prognostic factors in pediatric and adolescent epilepsy surgery. Epilepsia, 2011, 52(7):722-727.
16.	Kumar A, Chugani HT. Functional imaging:PET. Handb Clin Neurol, 2013, 111(12):767-776.
17.	Sunhee Kim, Noriko Salamon, Hollie AJ, et al. PET imaging in pediatric neuroradiology:current and future applications. Pediatr Radiol, 2010, 40(11):82-96.
18.	Engel J, Brown WJ, Kuhl DE, et al. Pathological findings underlying focal temporal lobe hypometabolism in partial epilepsy.Ann Neurol, 1982, 12(5):518-528.
19.	Sarazin M, Pillon B, Giannakopoulos P, et al. Clinicometabolic dissociation of cognitive functions and social behavior in frontal lobe lesions. Neurology, 1998, 51(5):142-148.
20.	Swartz BE, Halgren E, Delgado-Escueta AV, et al. Multidisciplinary analysis of patients with extratemporal complex partial seizures:predictive value of semiology. Epilepsy Res, 1990, 5(2):146-154.
21.	Swartz BE, Halgren E, Delgado-Escueta AV, et al. Multidisciplinary analysis of patients with extratemporal complex partial seizures:intertest agreement. Epilepsy Res, 1990, 5(1):61-73.
22.	Swartz BE, Theodore WH, Sanabria E, et al. Positron emission and single photon emission computed tomographic studies in the frontal lobe with emphasis on the relationship to seizure foci. Adv Neurol, 1992, 57(9):487-497.
23.	Jokeit H, Seitz RJ, Markowitsch HJ, et al. Prefrontal asymmetric interictal glucose hypometabolism and cognitive impairment in patients with temporal lobe epilepsy. Brain, 1997, 120(12):2283-2294.
24.	Weintrob DL, Saling MM, Berkovic SF, et al. Verbal memory in left temporal lobe epilepsy:evidence for taskrelated localization. Ann Neurol, 2002, 51(10):442-447.
25.	Rausch R, Henry TR, Ary CM, et al. Asymmetric interictal glucose hypometabolism and cognitive performance in epileptic patients. Arch Neurol, 1994, 51(11):139-144.
26.	Behen ME, Juhász C, Wolfe-Christensen C, et al. Brain damage and IQ in unilateral Sturge-Weber syndrome:Support for a "fresh start" hypothesis. Epilepsy Behav, 2011, 22(2):352-357.
27.	Carrie R, Mc Donald, Barbara E, et al. The relationship of regional frontal hypometabolism to executive function:a resting fluorodeoxyglucose PET study of patients with epilepsy and healthy controls. Epilepsy Behav, 2006, 9(1):58-67.
28.	Sattler JM. Age effects on Wechsler adult intelligence scale-revised tests. Consult Clin Psychol, 1982, 50(12):785-786.
29.	Hermann BP, Gold J, Pusakulich R, et al. Wechsler Adult Intelligence Scale-revised in the evaluation of anterior temporal lobectomy candidates. Epilepsia, 1995, 36(11):480-487.
30.	Kim H, Yi S, Son EI, et al.Differential effects of left versus right mesial temporal lobe epilepsy on Wechsler intelligence factors. Neuropsychology, 2003, 17(3):556-565.
31.	Lynn Blackburn, Gregory Lee, Michael Westerveld, et al, The Verbal IQ/Performance IQ discrepancy as a sign of seizure focus laterality in pediatric patients with epilepsy. Epilepsy Behav, 2007, 10(2):84-88.
32.	Sang-Ahm Lee, Chul-Ho Kim, Suk-Yoon Kang, et al. The lateralizing value of IQ in mesiotemporal epilepsy:differences between patients with unitemporal and bitemporal epileptiform discharges. Seizure, 2008, 17(5):604-610.
33.	Iverson GL, Mendrek A, Adams RL. The persistent belief that VIQ-PIQ splits suggest lateralized brain damage. Appl Neuropsychol, 2004, 11(2):85-90.

1. Jambaqué I, Pinabiaux C, Lassonde M. Cognitive disorders in pediatric epilepsy. Handb Clin Neurol, 2013, 111(6):691-695.
2. Dodrill CB. Neuropsychological effects of seizures. Epilepsy Behav, 2004, 5(1):21-24.
3. Seidenberg M, Dalin P, Bruce H, et al. Cognitive progression in epilepsy. Neuropsychol Rev, 2007, 17(4):445-454.
4. Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies:Report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia, 2010, 51(4):676-685.
5. 潘中允. PET/CT诊断学.北京:人民卫生出版, 2000:415-416.
6. 龚耀先, 蔡太生.中国修定韦氏儿童智力量表(C-WISC)手册.长沙:湖南地图出版社, 1993.
7. Gottlieb L, Zelko FA, Kim DS, et al. Cognitive proficiency in pediatric epilepsy. Epilepsy Behav, 2012, 23(11):146-151.
8. Davies G, Tenesa A, Payton A, et al. Genome-wide association studies establish that human intelligence is highly heritable and polygenic. Mol Psychiatry, 2011, 16(10):996-1005.
9. Mefford HC, Muhle H, Ostertag P, et al. Genome-wide copy number variation in epilepsy:novel susceptibility loci in idiopathic generalized and focal epilepsies. PLoS Genet, 2010, 6(5):e1000962.
10. Berg AT, Langfitt JT, Testa FM, et al. Global cognitive function in children with epilepsy:acommunity-based study. Epilepsia, 2008, 49(10):608-614.
11. Borden K, Burns T, O'Leary S. A comparison of children with epilepsy to an age-and IQ-matched control group on the children's memory scale. Child Neuropsychol, 2006, 12(5):165-172.
12. Walker N, Jackson D, Dabbs K, et al. Is lower IQ in children with epilepsy due to lower parental IQ? A controlled comparison. Dev Med Child Neurol, 2013, 55(20):278-782.
13. Terry Jones, Eugenii A, Rabiner JR. The development, past achievements, and future directions of brain PET. J Cerebral Blood Flow Metabol, 2012, 32(10):1426-1454.
14. Kumar A, Juhasz C, Asano E, et al. Objectiv e detection of epileptic foci by ¹⁸F-FDG PET in children undergoing epilepsy surgery. J Nucl Med, 2010, 51(12):1901-1907.
15. Kim YH, Kang HC, Kim DS, et al. Neuroimaging in identifying focal cortical dysplasia and prognostic factors in pediatric and adolescent epilepsy surgery. Epilepsia, 2011, 52(7):722-727.
16. Kumar A, Chugani HT. Functional imaging:PET. Handb Clin Neurol, 2013, 111(12):767-776.
17. Sunhee Kim, Noriko Salamon, Hollie AJ, et al. PET imaging in pediatric neuroradiology:current and future applications. Pediatr Radiol, 2010, 40(11):82-96.
18. Engel J, Brown WJ, Kuhl DE, et al. Pathological findings underlying focal temporal lobe hypometabolism in partial epilepsy.Ann Neurol, 1982, 12(5):518-528.
19. Sarazin M, Pillon B, Giannakopoulos P, et al. Clinicometabolic dissociation of cognitive functions and social behavior in frontal lobe lesions. Neurology, 1998, 51(5):142-148.
20. Swartz BE, Halgren E, Delgado-Escueta AV, et al. Multidisciplinary analysis of patients with extratemporal complex partial seizures:predictive value of semiology. Epilepsy Res, 1990, 5(2):146-154.
21. Swartz BE, Halgren E, Delgado-Escueta AV, et al. Multidisciplinary analysis of patients with extratemporal complex partial seizures:intertest agreement. Epilepsy Res, 1990, 5(1):61-73.
22. Swartz BE, Theodore WH, Sanabria E, et al. Positron emission and single photon emission computed tomographic studies in the frontal lobe with emphasis on the relationship to seizure foci. Adv Neurol, 1992, 57(9):487-497.
23. Jokeit H, Seitz RJ, Markowitsch HJ, et al. Prefrontal asymmetric interictal glucose hypometabolism and cognitive impairment in patients with temporal lobe epilepsy. Brain, 1997, 120(12):2283-2294.
24. Weintrob DL, Saling MM, Berkovic SF, et al. Verbal memory in left temporal lobe epilepsy:evidence for taskrelated localization. Ann Neurol, 2002, 51(10):442-447.
25. Rausch R, Henry TR, Ary CM, et al. Asymmetric interictal glucose hypometabolism and cognitive performance in epileptic patients. Arch Neurol, 1994, 51(11):139-144.
26. Behen ME, Juhász C, Wolfe-Christensen C, et al. Brain damage and IQ in unilateral Sturge-Weber syndrome:Support for a "fresh start" hypothesis. Epilepsy Behav, 2011, 22(2):352-357.
27. Carrie R, Mc Donald, Barbara E, et al. The relationship of regional frontal hypometabolism to executive function:a resting fluorodeoxyglucose PET study of patients with epilepsy and healthy controls. Epilepsy Behav, 2006, 9(1):58-67.
28. Sattler JM. Age effects on Wechsler adult intelligence scale-revised tests. Consult Clin Psychol, 1982, 50(12):785-786.
29. Hermann BP, Gold J, Pusakulich R, et al. Wechsler Adult Intelligence Scale-revised in the evaluation of anterior temporal lobectomy candidates. Epilepsia, 1995, 36(11):480-487.
30. Kim H, Yi S, Son EI, et al.Differential effects of left versus right mesial temporal lobe epilepsy on Wechsler intelligence factors. Neuropsychology, 2003, 17(3):556-565.
31. Lynn Blackburn, Gregory Lee, Michael Westerveld, et al, The Verbal IQ/Performance IQ discrepancy as a sign of seizure focus laterality in pediatric patients with epilepsy. Epilepsy Behav, 2007, 10(2):84-88.
32. Sang-Ahm Lee, Chul-Ho Kim, Suk-Yoon Kang, et al. The lateralizing value of IQ in mesiotemporal epilepsy:differences between patients with unitemporal and bitemporal epileptiform discharges. Seizure, 2008, 17(5):604-610.
33. Iverson GL, Mendrek A, Adams RL. The persistent belief that VIQ-PIQ splits suggest lateralized brain damage. Appl Neuropsychol, 2004, 11(2):85-90.

Journal of Epilepsy

Correlation between interictal cerebral glucose hypometabolism and IQ in children with epilepsy

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