PT  - JOURNAL ARTICLE
AU  - L. Tyvaert
AU  - S. Chassagnon
AU  - A. Sadikot
AU  - P. LeVan
AU  - F. Dubeau
AU  - J. Gotman
TI  - Thalamic nuclei activity in idiopathic generalized epilepsy
AID  - 10.1212/WNL.0b013e3181c55d02
DP  - 2009 Dec 08
TA  - Neurology
PG  - 2018--2022
VI  - 73
IP  - 23
4099  - http://n.neurology.org/content/73/23/2018.short
4100  - http://n.neurology.org/content/73/23/2018.full
SO  - Neurology2009 Dec 08; 73
AB  - Objective: Idiopathic generalized epilepsies (IGE) are characterized by specific EEG changes including 3- to 5-Hz generalized spike-and-wave discharges. The thalamus and its cortical interactions are considered essential in the production and propagation of spike-and-wave discharges. In animal studies, corticoreticular and limbic system property changes have been observed in absence seizures and during spike-and-wave discharges and suggest the involvement of different types of thalamic nuclei. With the development of deep brain stimulation in epilepsy, the role of the thalamic nuclei needs to be clarified in human IGE. Methods: Ten patients with IGE were recorded using 3T EEG-fMRI during spike-and-wave discharges. Hemodynamic response functions were calculated for 4 regions of interest corresponding to the anterior thalamic and centromedian and parafascicular (CM-Pf) nuclei of each thalamus. The time to peak of the hemodynamic response function was compared within thalamic structures (left compared to right) and between structures (anterior thalamic compared to CM-Pf nucleus). Results: CM-Pf and anterior nucleus are both activated during GSWDs. However, the positive time to peak in the CM-Pf (4.4 ± 2.5 s) occurred significantly earlier than in the anterior nucleus (7.6 ± 3.2 s). Conclusions: We demonstrated in humans the involvement of the centromedian and parafascicular part of the corticoreticular system and of the anterior nucleus part of the limbic system during generalized spike-and-wave discharges. The different time courses suggest that the posterior intralaminar nuclei may be involved in epileptic discharge initiation or early propagation, while the anterior nucleus may only play a role in its maintenance. These results may help to understand the clinical effect of deep brain stimulation within thalamic nuclei in intractable idiopathic generalized epilepsy patients. AN=anterior thalamic nucleus; BOLD=blood oxygenation level dependent; CAE=childhood absence epilepsy; CM-Pf=centromedian and parafascicular nucleus; GSWD=generalized spike-and-wave discharge; HRF=hemodynamic response function; IGE=idiopathic generalized epilepsy; JAE=juvenile absence epilepsy; JME=juvenile myoclonic epilepsy; ROI=region of interest.