Altered interictal cerebral blood flow in generalized tonic-clonic seizure: an arterial spin labeling based MRI study

Objective To study the alteration of interictal cerebral blood flow (CBF) of patients with generalized tonic-clonic seizure (GTCS) by pulsed arterial spin labeling (PASL), and uncover the neuropathophysiological mechanism of GTCS. Methods Twenty⁃nine patients with GTCS were included in this study, and the same number of age- and gender-matched healthy volunteers were set as controls. PASL data of all subjects were obtained on a Siemens MAGNETOM Trio 3.0T scanner. The regional cerebral blood flow of GTCS patients were compared with the controls by two-sample t-test. Results Compared with the controls, GTCS patients presented decreased regional cerebral blood flow in bilateral thalumus, brainstem and cerebellum, and also a part of cortical area of the right precuneus (P < 0.05, for all). The alteration of interictal regional cerebral blood flow in bilateral thalumus was not significantly related to seizure duration (r = -0.090, P = 0.643) and seizure frequency (r = -0.115, P = 0.551). Conclusion The decreased regional cerebral blood flow in bilateral thalumus, brainstem and cerebellum indicates the "mesencephalic epilepsy" theory in GTCS, which may contribute to the understanding of the pathophysiological mechanism of GTCS.