Surgical Treatment of MRI-Negative Temporal Lobe Epilepsy Based on PET: A Retrospective Cohort Study

Feng, Rui; Hu, Jie; Pan, Li; Shi, Jiali; Qiu, Chun; Lang, Liwei; Gu, Xin; Guo, Jun

doi:10.1159/000365575

Cited by 15 publications

(7 citation statements)

References 19 publications

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“…In a retrospective review of 60 cases in China with unilateral TLE, one-third of all patients were cryptogenic groups with positive PET findings. There was no significant difference between surgical outcomes of lesion group and non-lesion group (Engel class I 68.3 and 68.4%, respectively) [22]. Similar study was carried out by LoPinto-Khoury et al with 46 PET-positive cryptogenic TLE cases and 147 mesial temporal sclerosis cases.…”

Section: Neuro-imagingsupporting

confidence: 76%

Emerging Trends in the Management of Cryptogenic Epilepsy

Chow¹,

Poon²

2023

Epilepsy - Seizures Without Triggers

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Cryptogenic epilepsy, accounting for ~40% of adult-onset epilepsies and a lesser proportion in paediatrics, is defined as epilepsy of presumed symptomatic nature in which the cause has not been identified. It has a higher prevalence of refractory seizures when compared to those with idiopathic epilepsy (40 vs. 26%). These patients are usually treated with multiple anti-epileptic drugs, yet the total number of which used is inversely proportional to their efficacy. Moreover, these children may have significantly worse behavioural problems and can result in substantial cognitive impairments when older. Luckily, the number of cryptogenic epilepsy cases is diminishing due to better diagnostic abilities in recent years. We aim to divide this chapter into three parts. First, we hope to discuss our working algorithm and explain the use and advantages of different imaging modalities including high-field 3-Tesla MRI with morphological analysis for accurate localisation of the epileptogenic foci. We shall then elaborate the concept of the epileptogenic circuit and explore the selection criteria for more invasive approaches, such as depth electrodes and SEEG. Last but not the least, we aim to discuss the surgical treatments, including VNS and DBS, and their outcomes in these patients.

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Section: Neuro-imagingsupporting

confidence: 76%

Emerging Trends in the Management of Cryptogenic Epilepsy

Chow¹,

Poon²

2023

Epilepsy - Seizures Without Triggers

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“…It exhibits high sensitivity in detecting the epileptogenic zone (EZ) of cortical dysplasia (CD), which is known to occur in refractory epilepsy patients. Hence, FDG-PET contributes to localizing seizure onset zone (SOZ) in epilepsy surgery (6,7). It has furthermore demonstrated high sensitivity to detect hyper-metabolic areas in patients with refractory epilepsy (8).…”

Section: Introductionmentioning

confidence: 99%

Epileptogenic Zone Localization in Refractory Epilepsy by FDG-PET: The Comparison of SPM and SPM-CAT With Different Parameter Settings

Bacon

Jin

et al. 2021

Front. Neurol.

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Refractory epilepsy is a complex case of epileptic disease. The quantitative analysis of fluorodeoxyglucose positron emission tomography (FDG-PET) images complements visual assessment and helps localize the epileptogenic zone (EZ) for better curative treatment. Statistical parametric mapping (SPM) and its computational anatomy toolbox (SPM-CAT) are two commonly applied tools in neuroimaging analysis. This study compares SPM and SPM-CAT with different parameters to find the optimal approach for localizing EZ in refractory epilepsy. The current study enrolled 45 subjects, including 25 refractory epilepsy patients and 20 healthy controls. All of the 25 patients underwent surgical operations. Pathological results and the postoperative outcome evaluation by the Engel scale were likewise presented. SPM and SPM-CAT were used to assess FDG-PET images with three different uncorrected p-values and the corresponding cluster sizes (k), as in voxels in the cluster, namely p < 0.0002, k > 25; p < 0.001, k > 100; p < 0.005, and k > 200. When combining three settings, SPM and SPM-CAT yielded overall positive finding scores of 96.0% (24/25) and 100.0% (25/25) respectively. However, for the individual setting, SPM-CAT achieved the diverse positive finding scores of 96.0% (24/25), 96.0% (24/25), and 88.0% (22/24), which are higher than those of SPM [88.0% (22/25), 76.0% (19/25), and 72.0% (18/25)]. SPM and SPM-CAT localized EZ correctly with 28.0% (7/25) and 64.0% (16/25), respectively. SPM-CAT with parameter settings p < 0.0002 and k > 25 yielded a correct localization at 56.0% (14/25), which is slightly higher than that for the other two settings (48.0 and 20.0%). Moderate concordance was found between the confirmed and pre-surgical EZs, identified by SPM-CAT (kappa value = 0.5). Hence, SPM-CAT is more efficient than SPM in localizing EZ for refractory epilepsy by quantitative analysis of FDG-PET images. SPM-CAT with the setting of p < 0.0002 and k > 25 might perform as an objective complementary tool to the visual assessment for EZ localization.

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“…The importance of PET has been reported in several previous studies. For example, reports have shown that good surgical outcome is best predicted by the presence of hypometabolism in PET images, while the presence or absence of MRI pathology adds no further value to the predictive value of PET ( Carne et al, 2004 ; Choi et al, 2003 ; Feng et al, 2014 ; Gok et al, 2013 ; Kuba et al, 2011 ; LoPinto-Khoury et al, 2012 ; Struck et al, 2011 ; Yang et al, 2014 ). When comparing the predictive value of PET, MRI, and DTI, Thivard et al (2011) found that PET carries the most useful information to identify the SOZ, while DTI added predictive value only for cases with PET-negative findings.…”

Section: Discussionmentioning

confidence: 99%

Predicting the laterality of temporal lobe epilepsy from PET, MRI, and DTI: A multimodal study

Pustina

Avants

Sperling

et al. 2015

NeuroImage: Clinical

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Pre-surgical evaluation of patients with temporal lobe epilepsy (TLE) relies on information obtained from multiple neuroimaging modalities. The relationship between modalities and their combined power in predicting the seizure focus is currently unknown. We investigated asymmetries from three different modalities, PET (glucose metabolism), MRI (cortical thickness), and diffusion tensor imaging (DTI; white matter anisotropy) in 28 left and 30 right TLE patients (LTLE and RTLE). Stepwise logistic regression models were built from each modality separately and from all three combined, while bootstrapped methods and split-sample validation verified the robustness of predictions. Among all multimodal asymmetries, three PET asymmetries formed the best predictive model (100% success in full sample, >95% success in split-sample validation). The combinations of PET with other modalities did not perform better than PET alone. Probabilistic classifications were obtained for new clinical cases, which showed correct lateralization for 7/7 new TLE patients (100%) and for 4/5 operated patients with discordant or non-informative PET reports (80%). Metabolism showed closer relationship with white matter in LTLE and closer relationship with gray matter in RTLE. Our data suggest that metabolism is a powerful modality that can predict seizure laterality with high accuracy, and offers high value for automated predictive models. The side of epileptogenic focus can affect the relationship of metabolism with brain structure. The data and tools necessary to obtain classifications for new TLE patients are made publicly available.

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Surgical Treatment of MRI-Negative Temporal Lobe Epilepsy Based on PET: A Retrospective Cohort Study

Cited by 15 publications

References 19 publications

Emerging Trends in the Management of Cryptogenic Epilepsy

Emerging Trends in the Management of Cryptogenic Epilepsy

Epileptogenic Zone Localization in Refractory Epilepsy by FDG-PET: The Comparison of SPM and SPM-CAT With Different Parameter Settings

Predicting the laterality of temporal lobe epilepsy from PET, MRI, and DTI: A multimodal study

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