A group of 18 infants (age range, 10 mo to 5 yr) with infantile spasms and a common metabolic pattern on positron emission tomography (PET) is reported from the Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI. CT and MRI scans were negative for focal abnormalities. EEGs showed bilateral or multifocal epileptogenicity. All had bilateral hypometabolism in the temporal lobes on PET. Analysis of outcome of 14 of the subjects at a mean follow-up of 4 years revealed 1) severe developmental delay; 2) absent language development; and 3) an autistic disorder in 10. The hypometabolic areas were thought to represent cortical dysplasias, but the patients were not considered candidates for cortical resection. [1]

COMMENT. Children with infantile spasms associated with bitemporal glucose hypometabolism on PET appear to comprise a homogeneous group having a poor prognosis, delayed development and severe dysphasia, and autism. They are not candidates for cortical resection. About 10% of children with infantile spasms are autistic.

PET in epilepsy is reviewed from the University Hospital Center of Liege, Belgium [2]. The effect of valproate on cerebral metabolism and blood flow was investigated by deoxyglucose and 150 water PET at the NIH, Bethesda, MD [3]. VPA reduced regional cerebral blood flow but not cerebral metabolic rate for glucose in the thalamus, an effect associated with VPA’s mechanism of action in generalized seizures.