Dupont S, Semah F, Clémenceau S, Adam C, Baulac M, Samson Y
Service Hospitalier Fredéric Joliot, Commissariat à l'Energie Atomique, 91401 Orsay Cedex, France.
Arch Neurol. 2000 Sep;57(9):1331-6. doi: 10.1001/archneur.57.9.1331.
Recent studies suggest that positron emission tomography may be a reliable predictive indicator of clinical outcome following surgical treatment for epilepsy.
We evaluated 30 patients with documented medial temporal lobe epilepsy to determine if prediction of postoperative outcome is improved with the use of positron emission tomography with (18)fluorodeoxyglucose.
We performed a discriminant analysis to determine the combination of metabolic asymmetry indexes in temporal and extratemporal regions defined by magnetic resonance imaging that best predicted the postoperative outcome. Seizure outcome was assessed at least 2 years after surgery: patients were classified as seizure free (n = 14, group A), mostly improved (n = 10, group B), or as having persistent seizures (n = 6, group C).
Discriminant analysis was first performed in groups A and C. The temporal pole seemed to be the only temporal region for which metabolism was a significant predictor of the postoperative outcome (F(1,18) = 10.19; P =.005). The predictive value of positron emission tomography with (18)fluorodeoxyglucose was considerably improved by the multivariate analysis (F(4,15) = 7.21; P =.002), which correctly predicted the 2 -year prognosis in 100% of the patients using 4 regions: the temporal pole, the medial temporal region, the anterior part of the lateral temporal neocortex, and the basofrontal region. As a validation, we performed this 4-region analysis in the patients in group B. The difference among the 3 groups was highly significant (F = 15.5, P<.001).
These findings suggest that the interictal metabolic pattern reliably predicts the 2-year prognosis after surgery in patients with medial temporal lobe epilepsy.
近期研究表明，正电子发射断层扫描可能是癫痫手术治疗后临床结局的可靠预测指标。
我们评估了30例有记录的内侧颞叶癫痫患者，以确定使用氟代脱氧葡萄糖正电子发射断层扫描是否能改善术后结局的预测。
我们进行了判别分析，以确定磁共振成像所定义的颞叶和颞外区域代谢不对称指数的组合，该组合能最佳预测术后结局。术后至少2年评估癫痫发作结局：患者分为无癫痫发作（n = 14，A组）、大部分改善（n = 10，B组）或有持续性癫痫发作（n = 6，C组）。
首先在A组和C组进行判别分析。颞极似乎是唯一一个代谢是术后结局显著预测指标的颞叶区域（F(1,18) = 10.19；P =.005）。多变量分析显著提高了氟代脱氧葡萄糖正电子发射断层扫描的预测价值（F(4,15) = 7.21；P =.002），该分析使用4个区域正确预测了100%患者的2年预后：颞极、内侧颞叶区域、外侧颞叶新皮质前部和基底额叶区域。作为验证，我们在B组患者中进行了这一4区域分析。3组之间的差异非常显著（F = 15.5，P<.001）。
这些发现表明，发作间期代谢模式可可靠预测内侧颞叶癫痫患者术后2年的预后。
