Surgical outcome in patients with MRI-negative, PET-positive temporal lobe epilepsy

Capraz, Irem; Kurt, Gökhan; Akdemir, Ozgur; Hırfanoğlu, Tuğba; Oner, Yusuf; Şengezer, Tuğba; Atay, Lütfiye Özlem; Serdaroğlu, Ayşe; Bilir, Erhan

doi:10.1016/j.seizure.2015.03.015

Cited by 58 publications

(24 citation statements)

References 45 publications

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“…Regarding 18-FDG-PET scan, the study revealed its high sensitivity for EZL in true-DRE patients where it showed regional brain hypometabolism congruent with the SOZ in 87.5% of 3-T MRI non-lesional patients. These results are in harmony with that of Capraz and colleagues [27] as well as Desarnaud and colleagues [28] who identified that interictal 18-FDG-PET scan is the most sensitive procedure for localization of TLE as well as SOZ of extratemporal origin even for MRI-negative patients.…”

Section: Discussionsupporting

confidence: 88%

Long-term EEG monitoring and positron emission tomography in evaluating patients with drug-resistant epilepsy

Eissa

Bahnasy

Salama

et al. 2019

Egypt J Neurol Psychiatry Neurosurg

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Background: Drug-resistant epilepsy (DRE) is a commonly faced problem in epilepsy practice associated with great psychosocial consequences. This work aimed to study the role of seizure semiology analysis (SSA), long-term EEG monitoring, high field strength MRI, and positron emission tomography (PET) scan of the brain to confirm the diagnosis of true-RDE cases as well as seizure onset zone (SOZ) localization. Methods: This study was conducted on 67 DRE patients subjected to SSA, long-term video EEG, 3-Tesla MRI brain, and 18-FDG PET scan of brain. Results: Forty-three patients had true-DRE and 24 had non-epileptic episodic events (NEEE). The former group consisted of 23 patients with temporal lobe, 17 with frontal lobe, and 3 with occipital lobe epilepsies. Forty-eight patients had abnormal EEG included all patients with true-DRE and 5 patients with NEEE. Thirty patients had abnormal MRI brain findings in the form of mesial temporal sclerosis and/or focal cortical dysplasia. Sixteen true-DRE patients with normal 3-T MRI underwent PET scan of the brain where regional hypometabolism was detected in 14 (87.5%) of them. Conclusion: Practicing with DRE patients' needs meticulous assessment through detailed SSA, adequate neurophysiological long-term video EEG monitoring, and thorough neuroradiological investigation (structural and/or functional) to confirm the diagnosis of true-DRE and localize the SOZ as well as identification of patients with NEEE.

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Section: Discussionsupporting

confidence: 88%

Long-term EEG monitoring and positron emission tomography in evaluating patients with drug-resistant epilepsy

Eissa

Bahnasy

Salama

et al. 2019

Egypt J Neurol Psychiatry Neurosurg

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“…The mechanism underlying hypometabolism in epilepsy is believed to include neuronal loss, a decrease of synaptic density and diaschisis [2]. Hypometabolism observed in the ipsilateral temporal lobe is a finding that contributes to lateralization of epileptogenic focus in drug-resistant mesial temporal lobe epilepsy (TLE) patients undergoing surgical treatment [3][4][5][6][7][8]. The rate of ipsilateral temporal hypometabolism in TLE varies between 60% and 100% depending on the different analysis methods used and differences in patient groups in the studies [1].…”

Section: Introductionmentioning

confidence: 99%

“…The rate of ipsilateral temporal hypometabolism in TLE varies between 60% and 100% depending on the different analysis methods used and differences in patient groups in the studies [1]. This finding also has a significant prognostic impact regarding patient outcomes [1,5,[7][8][9][10][11][12]. In a metaanalysis of 46 publications (between 1992 and 2006), it was shown that hypometabolism in the ipsilateral temporal lob in TLE patients had a predictive value of 86% for a good postsurgical outcome [4].…”

Section: Introductionmentioning

confidence: 99%

“…Predictive values of the same finding in TLE patients with normal magnetic resonance imaging (MRI) and nonlocalized ictal scalp electroencephalography (EEG) were 80% and 72%, respectively [4]. Therefore, brain FDG PET imaging may contribute to patient management, especially in cases where the patient's brain MRI findings are normal and clinical findings are inconclusive [1,4,8,13].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of brain FDG PET images in temporal lobe epilepsy for lateralization of epileptogenic focus using data mining methods

Akdemir¹,

Capraz²,

Ateş³

et al. 2020

Turk J Med Sci

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Background/aim: In temporal lobe epilepsy (TLE), brain positron emission tomography (PET) performed with F-18 fluorodeoxyglucose (FDG) is commonly used for lateralization of the epileptogenic temporal lobe. In this study, we aimed to evaluate the success of quantitative analysis of brain FDG PET images using data mining methods in the lateralization of the epileptogenic temporal lobe. Materials and methods: Presurgical interictal brain FDG PET images of 49 adult mesial TLE patients with a minimum of 2 years of postsurgical follow-up and Engel I outcomes were retrospectively analyzed. Asymmetry indices were calculated from PET images from the mesial temporal lobe and its contiguous structures. The J48 and the logistic model tree (LMT) data mining algorithms were used to find classification rules for the lateralization of the epileptogenic temporal lobe. The classification results obtained by these rules were compared with the physicians' visual readings and the findings of single-patient statistical parametric mapping (SPM) analyses in a test set of 18 patients. An additional 5-fold cross-validation was applied to the data to overcome the limitation of a relatively small sample size. Results: In the lateralization of 18 patients in the test set, J48 and LMT methods were successful in 16 (89%) and 17 (94%) patients, respectively. The visual consensus readings were correct in all patients and SPM results were correct in 16 patients. The 5-fold crossvalidation method resulted in a mean correct lateralization ratio of 96% (47/49) for the LMT algorithm. This ratio was 88% (43 / 49) for the J48 algorithm. Conclusion: Lateralization of the epileptogenic temporal lobe with data mining methods using regional metabolic asymmetry values obtained from interictal brain FDG PET images in mesial TLE patients is highly accurate. The application of data mining can contribute to the reader in the process of visual evaluation of FDG PET images of the brain.

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“…Malformation of cortical development (MCD) and hippocampal sclerosis are the commonly encountered focal brain pathologies on surgical series in patients with MRI-negative epilepsy (2). Moreover, 40–80% of patients with MRI-negative epilepsy are likely to be seizure-free (78); whereas MRI-positive patients have a greater than two-fold surgical-success rate to achieve freedom from seizures, as compared to MRI-negative patients (9). …”

Section: Introductionmentioning

confidence: 99%

Value of Repeat Brain MRI in Children with Focal Epilepsy and Negative Findings on Initial MRI

et al. 2017

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ObjectiveTo evaluate the value of repeat brain magnetic resonance imaging (MRI) in identifying potential epileptogenic lesions in children with initial MRI-negative focal epilepsy.Materials and MethodsOur Institutional Review Board approved this retrospective study and waived the requirement for informed consent. During a 15-year period, 257 children (148 boys and 109 girls) with initial MRI-negative focal epilepsy were included. After re-evaluating both initial and repeat MRIs, positive results at repeat MRI were classified into potential epileptogenic lesions (malformation of cortical development and hippocampal sclerosis) and other abnormalities. Contributing factors for improved lesion conspicuity of the initially overlooked potential epileptogenic lesions were analyzed and classified into lesion factors and imaging factors.ResultsRepeat MRI was positive in 21% (55/257) and negative in 79% cases (202/257). Of the positive results, potential epileptogenic lesions comprised 49% (27/55) and other abnormalities comprised 11% of the cases (28/257). Potential epileptogenic lesions included focal cortical dysplasia (n = 11), hippocampal sclerosis (n = 10), polymicrogyria (n = 2), heterotopic gray matter (n = 2), microlissencephaly (n = 1), and cortical tumor (n = 1). Of these, seven patients underwent surgical resection. Contributing factors for new diagnoses were classified as imaging factors alone (n = 6), lesion factors alone (n = 2), both (n = 18), and neither (n = 1).ConclusionRepeat MRI revealed positive results in 21% of the children with initial MRI-negative focal epilepsy, with 50% of the positive results considered as potential epileptogenic lesions. Enhanced MRI techniques or considering the chronological changes of lesions on MRI may improve the diagnostic yield for identification of potential epileptogenic lesions on repeat MRI.

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Surgical outcome in patients with MRI-negative, PET-positive temporal lobe epilepsy

Abstract: Our results suggest that epilepsy surgery outcomes of MRI-negative, PET positive patients are similar to those of patients with MTS. This finding may aid in the selection of best candidates for epilepsy surgery.

Cited by 58 publications

References 45 publications

Long-term EEG monitoring and positron emission tomography in evaluating patients with drug-resistant epilepsy

Long-term EEG monitoring and positron emission tomography in evaluating patients with drug-resistant epilepsy

Evaluation of brain FDG PET images in temporal lobe epilepsy for lateralization of epileptogenic focus using data mining methods

Value of Repeat Brain MRI in Children with Focal Epilepsy and Negative Findings on Initial MRI

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