Assessment of the role of FDG PET in the diagnosis and management of children with refractory epilepsy

Ollenberger, Glenn P.; Byrne, Amanda; Berlangieri, Salvatore U; Rowe, Christopher C.; Pathmaraj, Kunthi; Reutens, David C.; Berkovic, Samuel F.; Scheffer, Ingrid E.; Scott, Andrew M.

doi:10.1007/s00259-005-1844-6

Cited by 50 publications

(26 citation statements)

References 13 publications

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“…28 Like MRI, however, interpretation of grayscale FDG-PET scans is less sensitive for type I compared with type II CD. 15,[29][30][31][32] Furthermore, intracranial EEG ictal onset zones are often diffuse and illdefined in patients with CD. 33,34 Consequently, determining the location and borders of the surgical resection is challenging in CD patients to completely remove the lesion, especially for patients with type I CD, where the area generating seizures often overlaps with functional cortex and the structural brain abnormalities are relatively subtle.…”

Section: Correlations Between Neuroimaging and Clinical Vari-mentioning

confidence: 99%

FDG-PET/MRI coregistration improves detection of cortical dysplasia in patients with epilepsy

Salamon¹,

et al. 2008

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Objective: Patients with cortical dysplasia (CD) are difficult to treat because the MRI abnormality may be undetectable. This study determined whether fluorodeoxyglucose (FDG)-PET/MRI coregistration enhanced the recognition of CD in epilepsy surgery patients. UCLA MRI identified CD in 78% of patients, and 37% of type I CD cases had normal UCLA scans. EEG and neuroimaging findings were concordant in 52% of type I CD patients, compared with 89% of type II CD patients. FDG-PET scans were positive in 71% of CD cases, and type I CD patients had less hypometabolism compared with type II CD patients. Postoperative seizure freedom occurred in 82% of patients, without differences between type I and type II CD cases. Cortical dysplasia (CD), first described in 1971, 1 is the most common malformation of cortical development identified in surgically treated patients with therapy-resistant epilepsy. Methods: Conclusions:2,3 The histopathology of CD is classified into mild Palmini type I and severe Palmini type II.4,5 Type I CD is characterized by cortical dyslamination and columnar disorganization often associated with excessive subcortical white matter neurons. Type II CD shows cortical disorganization plus abnormal dysmorphic or cytomegalic neurons with or without balloon cells. 6 In the past decade, improvements in MRI have increased awareness that CD is a frequent substrate causing epilepsy. This is especially true for patients with type II CD in whom structural MRI and functional neuroimaging often identify the lesion. 7-10 However, patients with type I CD are a challenge in that they often have negative MRI scans, making surgical treatment difficult without knowing the exact location and borders necessary for complete lesion removal.

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Section: Correlations Between Neuroimaging and Clinical Vari-mentioning

confidence: 99%

FDG-PET/MRI coregistration improves detection of cortical dysplasia in patients with epilepsy

Salamon¹,

et al. 2008

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“…In other words, PET uncovered unifocal or multifocal metabolic abnormalities in 95% of the cryptogenic cases. In the study by Ollenberger et al, 28 the role of PET in the diagnosis and management of children with refractory epilepsy was assessed from the clinician's perspective. Three epileptologists completed the questionnaires in reference to 113 evaluable patients.…”

Section: F-fdg Petmentioning

confidence: 99%

The Utility of Positron Emission Tomography in Epilepsy

Burneo

Poon

Kellett

et al. 2015

Can. J. Neurol. Sci.

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The role of fludeoxyglucose F 18 positron emission tomography (PET) in the presurgical evaluation of patients with medically intractable epilepsy continues to be refined. The purpose of this study was to systematically review the literature to assess the diagnostic accuracy and utility of PET in this setting. Thirty-nine studies were identified through MEDLINE and EMBASE databases that met the inclusion criteria. In adult patients, PET hypometabolism showed a 56 to 90% agreement with seizure onset localized by intracranial electroencephalogram (pediatric: 21 to 86%). In temporal lobe epilepsy patients with good surgical outcome, PET displayed moderate to high sensitivity in localizing the seizure focus (range: 71 to 89%). The sensitivity increased by 8 to 23% when PET results were combined with magnetic resonance imaging or electroencephalogram. PET has been shown to affect patient management by improving the guidance of intracranial electrodes placement, altering the decision to perform surgery, or excluding patients from further evaluation.RÉSUMÉ: Utilité de la tomographie par émission de positons dans l'épilepsie. Le rôle de la tomographie par émission de positons (PET scan) au 18F fluodésoxyglucose (18F-FDG) dans l'évaluation préchirurgicale de patients présentant une épilepsie réfractaire au traitement médical est constamment raffiné. Le but de cette étude était de revoir systématiquement la littérature afin d'évaluer la précision du diagnostic et l'utilité du PET scan dans ce contexte. Nous avons identifié 39 études dans les bases de données MEDLINE et EMBASE qui rencontraient nos critères d'inclusion. Chez les patients adultes, un hypométabolisme au PET scan concordait entre 56 et 90% avec le début de la crise localisé par l'électroencéphalographie intracrânienne (patients pédiatriques: entre 21 et 86%). Chez les patients atteints d'épilepsie temporale chez qui le résultat chirurgical avait été favorable, le PET scan avait une sensibilité de modérée à élevée pour localiser le foyer épileptogène (écart : 71 à 89%). La sensibilité augmentait de 8 à 23% quand les résultats du PET scan étaient combinés à l'imagerie par résonance magnétique ou à l'électroencéphalographie. Il est démontré que le PET scan influence le traitement du patient en améliorant le guidage lors de la mise en place des électrodes intracrâniennes, en modifiant la décision de procéder à une chirurgie ou en évitant de procéder à des examens plus poussés chez certains patients.

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“…Bu düşüklüğün en önemli nedeni lezyon boyutlarının küçük olmasıdır (53,54). PET hastaların yaklaşık %50-70'inde tedavi planını değiştirmektedir (55). MR'de odak tespit edilen hastalarda epilepsi cerrahisi sonrası nöbetsizlik oranı 3 kat fazla olmasına rağmen cerrahi tedavi ile bu hastaların 1/3-1/4'ü yine başarısız olacak ve hastaların yaklaşık %40'ında antiepileptik ilaç kullanımı cerrahi sonrası dönemde devam edecektir (56,57,58).…”

Section: Epilepsiodağınagörealttiplerunclassified

Nuclear Medicine Methods in Epilepsy

Koç¹,

Kara²

2017

Nts

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Öz Abstract GirişEpilepsi nöbetlerle karakterize bir hastalık olup hastaların önemli bir kısmı tedaviye dirençlidir veya bir noktada direnç kazanır. Bu nedenle epilepsi cerrahisi özellikle status epileptikus hastaları gibi bazı hastalar için gerekli bir tedavi yöntemidir (1). Hastalığa bağlı morbidite ve hatta mortalite, ilaçlara bağlı yan etkiler nedeniyle cerrahi tedavinin öneminin ve yaygınlığının artması kaçınılmazdır (2,3). Fonksiyonel görüntüleme yöntemlerindeki gelişmelere rağmen epileptik odağın tespiti hali hazırda zordur.Nükleer tıp görüntüleme yöntemlerinden bu alanda kullanılanlar Tc-99m hidroksimetilenpropilenaminoksim (HMPAO) veya etilensisteindimer (ECD) ile beyin tek foton emisyon tomografi (SPECT) veya florodeoksiglukoz (FDG) ile beyin pozitron emisyon tomografidir (PET). Bunun dışında diğer ajanlarla PET çalışmaları da yapmak mümkün olup ülkemizde geri ödeme kapsamında kullanılan yöntem FDG PET'dir. Görüntüleme çalışmaları enjeksiyon yapıldığı zaman aralığına göre iktal (nöbet anında), interiktal (nöbetsiz dönemde) veya postiktal (nöbetten hemen sonra) olarak tanımlanır. Tercihen iktal SPECT ve interiktal PET diğer yöntemlere göre daha bilgi vericidir. Ancak hastanın iktal dönemde yakalanarak enjeksiyon yapılması konusundaki teknik ve donanımsal eksiklikler nedeni ile iktal SPECT çalışmaları önemli zorluklar taşımaktadır. Bu derleme kapsamında şu konularda bilgiler vermeye çalışacağız: Epilepsi cerrahisinin tanımı ve endikasyonları, epilepsi cerrahisi öncesi odak belirleme çalışmaları (özellikle nükleer tıp yöntemleri) nükleer tıp görüntüleme yöntemlerinin endikasyonları, uygulama yöntemleri ve güncel literatür bilgileri. 161Epilepsi hastalarında nükleer tıp yöntemlerinden en yaygın kullanılanı ilaca dirençli epilepside cerrahi tedavi öncesi epileptik odak belirlenmesi amacıyla yapılan fonksiyonel görüntüleme çalışmalarıdır. Tc-99m işaretli hidroksimetilenpropilenamin oksim ile iktal veya interiktal dönemde yapılan tek foton emisyonu/bilgisayarlı tomografi ve interiktal dönemde yapılan florodeoksiglukoz pozitron emisyon tomografi bu yöntemler arasında en ulaşılabilir durumda olanlarıdır. Bu bölümde epilepsi hastalarında yaygın olarak terch edilen nükleer tıp yöntemlerinden, bunların kullanım alanlarından, avantajlarından ve sağladığı bilgilerden bahsedilerek bulgular güncel yayınların ışığında tartışılacaktır. Anahtarkelimeler: Epilepsi, epileptik odak, SPECT, PETThe most common nuclear medicine methods in epilepsy are the imaging methods that aim to determine the epileptic focus before the surgery in drug-resistant epilepsy. The most available methods are ictal and interictal Tc-99m HMPAO SPECT and interictal fluorodeoxyglucose positron emission tomography. In this review we will discuss about the Nuclear Medicine methods and the fields, advantages, and-up-to date information provided by these methods in epilepsy patients with review of recent literature.

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Assessment of the role of FDG PET in the diagnosis and management of children with refractory epilepsy

Abstract: FDG PET has a definite role in the assessment of paediatric patients with refractory epilepsy who are being considered for surgery. In the future, analysis of FDG PET data in specific subpopulations of children with refractory epilepsy may lead to novel insights regarding aetiology.

Cited by 50 publications

References 13 publications

FDG-PET/MRI coregistration improves detection of cortical dysplasia in patients with epilepsy

FDG-PET/MRI coregistration improves detection of cortical dysplasia in patients with epilepsy

The Utility of Positron Emission Tomography in Epilepsy

Nuclear Medicine Methods in Epilepsy

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