Sturge–Weber syndrome: Correlation between clinical course and FDG PET findings

Objective: To determine whether the extent and degree of glucose hypometabolism defined by PET correlate with seizure characteristics, cognitive function, and interictal EEG abnormalities in children with unilateral cerebral involvement of Sturge–Weber syndrome (SWS). Methods: 2-Deoxy-2[18F]fluoro-d-glucose (FDG) PET was performed in 13 children (age range 0.7 to 15.1 years; five boys, eight girls) with unilateral SWS. Based on asymmetries between homologous cortical areas in FDG PET images, cortical areas of mildly (10% to 20% decrease), and severely (>20% decrease) asymmetric cortical metabolism were defined. These areas were normalized to the size of the ipsilateral hemisphere and correlated with clinical seizure characteristics, full-scale IQ, and interictal EEG abnormalities. Results: Both seizure frequency ( p = 0.027) and lifetime number of seizures ( p = 0.017) showed a positive correlation with the area (expressed as the percentage of cortical area of ipsilateral hemisphere) of mildly asymmetric cortical metabolism. Patients with higher IQ had a shorter duration of epilepsy ( p = 0.044) and a larger area of severely asymmetric cortical metabolism ( p = 0.044). Patients with bilateral interictal EEG abnormalities had larger lifetime number of seizures ( p = 0.042), lower IQ ( p = 0.024), and smaller area of severely asymmetric cortical metabolism ( p = 0.019) than those with only ipsilateral EEG abnormalities. Conclusions: Association of severely asymmetric cortical metabolism with relatively preserved cognitive function in SWS suggests that functional reorganization occurs more readily when cortex is severely rather than mildly damaged. Therefore, the area of mildly asymmetric cortical metabolism may exert a nociferous effect on the remaining of the brain. Thus, the extent and degree of glucose asymmetry detected by PET are sensitive markers of seizure severity and cognitive decline in SWS.