Abstract
The effect of seizures on cerebral metabolites have been evaluated in animals but has not been studied previously in humans. We used 31-P NMR spectroscopy to measure changes in the cerebral phosphocreatine (PCr) to inorganic phosphate (Pi) ratio and to calculate intracellular pH (pHi) in five infants with seizures. Three babies developed seizures after perinatal asphyxia; two infants had the onset of seizures beyond the neonatal period (4 wk of unknown etiology; 11 wk due to intracranial hemorrhage). When studied the infants were clinically stable on anticonvulsants. Metabolic changes were present on initial study and varied with time between most recent seizure and NMR. Major changes were seen in two children with subtle seizures during the study and focal abnormalities on EEC: PCr/Pi ∼.75 in the hemisphere with seizures and ∼1.6 in the contralateral hemisphere. Two patients with focal seizures, but no clinical manifestations during the NMR study, had less severe metabolic abnormalities on the side of EEC abnormality (∼ .87 vs 1.18). The fifth child with asphyxia, prolonged status epilepticus and grade 4 IVH had marked bilateral changes (PCr/Pi ∼ .5) that improved with more aggressive anticonvulsant management (PCr/Pi ∼ 1.2). Interhemispheric differences in pHi were not significant (7.1 ± .4 in hemisphere with seizures vs 7.2 ± .2) suggesting that CBF was sufficient to remove lactate generated by anaerobic glycolysis. Four patients had serial studies that showed improvement in cerebral metabolite ratios, suggesting that the initial changes were not due to structural damage. Our results suggest that human seizures cause significant cerebral metabolic stress and may cause or exacerbate neurologic damage.
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Younkin, D., Maris, J., Donlon, E. et al. 1721 THE EFFECT OF SEIZURES ON CEREBRAL METABOUTES IN CHILDREN. Pediatr Res 19, 397 (1985). https://doi.org/10.1203/00006450-198504000-01739
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DOI: https://doi.org/10.1203/00006450-198504000-01739