Theodore W H, Sato S, Kufta C, Balish M B, Bromfield E B, Leiderman D B
Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD 20892.
Ann Neurol. 1992 Dec;32(6):789-94. doi: 10.1002/ana.410320613.
We evaluated the role of positron emission tomography (PET) with [18F]deoxyglucose (FDG) (FDG-PET) for planning surgery in 53 patients who had temporal lobectomy for uncontrolled seizures at National Institutes of Health from 1981 to 1990. Investigators blinded to PET data used results of telemetered video-electroencephalographic ictal monitoring and other standard criteria to decide whether subdural electrodes (22 patients, i.e., the "invasive" group) should be implanted or surgery performed. PET scans were analyzed using a standard regional template. Mean lateral but not mesial temporal asymmetry was significantly higher in patients who became seizure free (p < 0.03). Patients with > or = 15% hypometabolism were significantly more likely to be seizure free in the entire study population and the invasive subgroup. Visual identification of hypometabolism was less accurate. When a clear temporal ictal surface electroencephalographic focus was present, FDG-PET provided less additional information. FDG-PET may be particularly valuable if the surface electroencephalographic scan is nonlocalizing. In addition to helping to identify the seizure focus, it may allow limitation of invasive electrode placement to those necessary for functional mapping. When PET is used to identify epileptic foci, quantitative measurements of asymmetry should be made.
我们评估了1981年至1990年间在美国国立卫生研究院接受颞叶切除术治疗难治性癫痫的53例患者中，[18F]脱氧葡萄糖正电子发射断层扫描（PET）（FDG-PET）在手术规划中的作用。对PET数据不知情的研究人员使用遥测视频脑电图发作监测结果和其他标准来决定是否应植入硬膜下电极（22例患者，即“侵入性”组）或进行手术。PET扫描使用标准区域模板进行分析。癫痫发作缓解的患者平均颞叶外侧而非内侧不对称性显著更高（p < 0.03）。在整个研究人群和侵入性子组中，代谢减低≥15%的患者癫痫发作缓解的可能性显著更高。通过视觉识别代谢减低的准确性较低。当存在明确的颞叶发作期表面脑电图病灶时，FDG-PET提供的额外信息较少。如果表面脑电图扫描不能定位，FDG-PET可能特别有价值。除了有助于识别癫痫病灶外，它还可以将侵入性电极的放置限制在功能定位所需的范围内。当使用PET识别癫痫病灶时，应进行不对称性的定量测量。
