Faculty Bibliography

Previously, using positron emission tomography (PET), we showed that local cerebral metabolic rates for glucose (lCMRglc) in children undergo dynamic maturational trends before reaching adult values. In order to develop an animal model that can be used to explore the biological significance of the different segments of the lCMRglc maturational curve, we measured lCMRglc in kittens at various stages of postnatal development and in adult cats using quantitative [14C]2-deoxyglucose autoradiography. In the kitten, very low lCMRglc levels (0.14 to 0.53 mumol min-1 g-1) were seen during the first 15 days of life, with phylogenetically older brain regions being generally more metabolically mature than newer structures. After 15 days of age, many brain regions (particularly telencephalic structures) underwent sharp increases of lCMRglc to reach, or exceed, adult rates by 60 days. This developmental period (15 to 60 days) corresponds to the time of rapid synaptic proliferation known to occur in the cat. At 90 and 120 days, a slight decline in lCMRglc was observed, but this was followed by a second, larger peak occurring at about 180 days, when sexual maturation occurs in the cat. Only after 180 days did lCMRglc decrease to reach final adult values (0.21 to 2.04 mumol min-1 g-1). In general, there was good correlation between the metabolic maturation of various neuroanatomical regions and the emergence of behaviors mediated by the specific region. At least in the kitten visual cortex, which has been extensively studied with respect to developmental plasticity, the "critical period" corresponded to that portion of the lCMRglc maturational curve surrounding the 60-day metabolic peak. These normal maturational lCMRglc data will serve as baseline values with which to compare anatomical and metabolic plasticity changes induced by age-related lesions in the cat.

The relationship between focal disturbances of glucose utilization demonstrated by positron emission tomography (PET) and electrophysiologic abnormalities defined by intraoperative electrocorticography (ECoG) was studied in eight children (aged 13 months to 12 years) who underwent cortical resection because of intractable seizures. None of the children had pure temporal lobe epilepsy. Computed tomography (CT) and/or magnetic resonance imaging (MRI) were normal in four of the eight children. The scalp electroencephalogram (EEG) showed lateralized interictal epileptiform abnormalities in all eight and lateralized ictal onset in five of eight. In seven children, interictal PET showed focal hypometabolism; the eighth child had focal, ictal hypermetabolism. ECoG at the time of surgery showed epileptiform spiking, slowing, and/or suppression of normal background activity that in every case corresponded to the focus on PET scan. The ECoG findings support the notion that in children with epilepsy focal metabolic abnormalities on PET correspond to electrophysiologically abnormal areas of cortex, which are presumably also the epileptogenic regions. Such areas can appear normal on anatomic imaging studies (CT and MRI). When ictal scalp EEG data are ambiguous or contradictory, PET provides a less invasive means than chronic grid or depth electrode recording for evaluating whether a localized epileptogenic area exists.

Positron emission tomography (PET) of local cerebral glucose metabolism in 13 children with infantile spasms of undetermined cause (cryptogenic spasms) revealed unilateral hypometabolism involving the parieto-occipito-temporal region in 5 female infants. Cranial computed tomography showed normal findings in all infants. Magnetic resonance imaging (MRI) demonstrated a normal appearance in 4 of the 5 infants; in 1 infant, MRI revealed a subtle abnormality consisting of poor demarcation between occipital gray and white matter. Surface electroencephalography (EEG) in 4 showed hypsarrythmia at some time in the patients' courses, but at other times showed localized or lateralized abnormalities corresponding to areas of PET-detected hypometabolism. Because of poor seizure control, 4 infants underwent surgical removal of the cortical focus guided by intraoperative electrocorticography and were seizure free postoperatively. Neuropathological examination of resected tissue in each showed microscopic cortical dysplasia. Our findings indicate that in infants with cryptogenic spasms, PET can effectively identify those due to unsuspected focal cortical dysplasia, for which resective surgery offers improved prognosis.

We analyzed the available ontogenetic data (birth to 30 years of age) for: amplitude of delta EEG (DA) waves during sleep; cortical metabolic rate (CMR) measured with positron emission tomography; and synaptic density (SD) in frontal cortex. Each is at the adult level at birth, increases to about twice this level by 3 years of age, and then gradually falls back to the adult level over the next two decades. Statistical analyses revealed that individual gamma distribution models fit each data set as well as did the best ad hoc polynomial. A test of whether a single gamma distribution model could describe all three data sets gave good results for DA and CMR but the fit was unsatisfactory for SD. However, because so few data were available for SD, this test was not conclusive. We proposed the following model to account for these changes. First, cortical neurons are stimulated by birth to enter a proliferative state (PS) that creates many connections. Next, as a result of interactions in the PS, neurons are triggered into a transient organizational state (OS) in which they make enduring connections. The OS has a finite duration (minutes to years), and is characterized by high rates of information-processing and metabolism. Levels of CMR, SD and DA, therefore, are proportional to the number of neurons in the OS at any time. Thus, the cortex after birth duplicates, over a vastly greater time scale, the overproduction and regression of neural elements that occurs repeatedly in embryonic development. Finally, we discussed the implications of post-natal brain changes for normal and abnormal brain function. Mental disorders that have their onset after puberty (notably schizophrenia and manic-depressive psychoses) might be caused by errors in these late maturational processes. In addition to age of onset, this neurodevelopmental hypothesis might explain several other puzzling features of these subtle disorders.

We measured local cerebral metabolic rate for glucose (ICMRGIc) using positron emission tomography (PET) in six children with Sturge-Weber syndrome (SWS) and in six neurologically asymptomatic children with facial capillary hemangioma suggestive of SWS. Children with advanced SWS showed markedly depressed ICMRGIc in the anatomically affected cerebral hemisphere in a distribution that extended beyond the abnormalities depicted on computed tomography scan. In two infants with SWS and recent seizure onset, interictal PET revealed a paradoxical pattern of increased ICMRGIc in the cerebral cortex of the anatomically affected hemisphere. In one of these infants, ICMRGIc was also increased in the contralateral cerebellum, suggesting activation of the cortico-ponto-cerebellar circuitry. Subsequent PET (28 months later) in this child revealed the typical ICMRGIc pattern seen in advanced SWS. Further study of this transient ICMRGIc increase may be important in disclosing the pathogenesis of unilateral cerebral degeneration in SWS. In neurologically asymptomatic children with the facial stigmata of SWS and in children with early SWS, PET provides a sensitive measure of the extent and degree of cerebral metabolic impairment. Serial PET studies in children with SWS can be used to assess disease progression and, together with computed tomography or magnetic resonance imaging, may be useful in the selection of suitable candidates for cerebral hemispherectomy or focal cortical resection.