Photosensitive Epilepsy Studied by Functional Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy

PURPOSE: To study metabolic and hemodynamic correlates of photic stimulation-triggered discharges. METHODS: Simultaneous EEG, functional MRI (tMRI) and magnetic resonance spectroscopy (MRS) were performed in nine patients with photosensitive epilepsy and in 12 normal subjects. RESULTS: Prominent visual cortex activation was seen in all normal subjects and patients, and no tMRI-registered hemodynamic abnormalities were correlated with the brief photoparoxysmal spike-wave activity evoked in the photosensitive patients. However, irrespective of the presence of a spike-wave response to the photic stimulation, the photosensitive patients showed four findings not seen in the normal subjects: (a) slightly, but significantly, elevated lactate levels in the occipital cortex in the resting state; (b) an increased area of visual cortical activation with photic stimulation; (c) simultaneous with the occipital cortex stimulus-induced increased fMRI signal, there were noncontiguous areas of signal attenuation most prominent in perirolandic regions; and (d) a marked decrement (undershoot) of fMRI signal intensity immediately after the photic stimulation in the occipital cortex and in the region of the posterior cingulate gyrus. CONCLUSIONS: These findings suggest abnormal interictal metabolism and increased vascular reactivity in the photosensitive patients.