The significance of periodic sharp-wave complexes in Creutzfeldt-Jakob disease

J Korean Neurol Assoc > Volume 15(5); 1997 > Article

Journal of the Korean Neurological Association 1997;15(5): 1064-1072.

크로이츠펠트-야콥병의 주기적 예파 복합체에 대한 연구

서대원, 나덕렬, 홍승봉, 김요식, 김경원, 이광호

성균관대학교 의대 삼성서울병원, 원광대학교 의대, 마산의료원 신경과

The significance of periodic sharp-wave complexes in Creutzfeldt-Jakob disease

Dae Won Seo, M.D. , Duk L. Na M.D. , Seung Bong Hong, M.D. , Yo-Sik Kim*, M.D. Keyoung Won Kim**, M.D. , Kwang ho Lee, M.D.

Dept of Neurology, Samsung Medical Center, Sung Kyun Kwan Univ., WonKwang Univ. , Masan Medical Center**

Abstract

The pattern of periodic sharp wave complexes (PSWC) was widely accepted as the most characteristic electroencepalographic(EEG) abnormality in Creutzfeldt-Jakob disease (CJD) although it may be lacking in prodromal and terminal stages. The EEG abnormalities are often asymmetric. We compared PSWC with 18F-FDG PET and brain MRI finding to know the signifcance of PSWC. All the patients had typical clinical courses and symptoms of CJD. Three patients were pathologically verified. Three patients were in full stage and two in terminal stage of CJD. We analysed PSWC in digital EEG and compared the regions of maximal PSWC amplitudes with 18F-FDG PET and brain-MRI finding in regard to lateralization and localization. Regarding lateralization, the maximal amplitudes of PSWC were observed over left frontal area in two patients and over right frontal region in three. Three patients in full stage had PET hypometabolism in the same hemisphere as PSWC were lateralized. Their brain MRI showed abnormal basal ganglia intensities but no sever brain atrophy. Two patients in terminal stage had PSWC lateralized in right frontal region but in PET one had left frontoparietal and the other bilateral global hypometabolism. Their brain-MRI showed severe cortical atrophy in the same hemisphere as PET hypometabolism was observed. Regarding all patients in full or terminal stage had maximal PSWC in frontal region, which were not consistent with PET and MRI findings. Cortical lesions in MRI were well corresponding with PET hypometabolism but not with PSWC. These results suggest that PSWC could reflect the hemisphere with more CJD activities in full stage, but could not localize the region where PET and MRI showed abnormalities, suggesting that the generation of PSWC could be related with the involvement of subcortical structures in CJD.