Benedek Krisztina, Juhász Csaba, Muzik Otto, Chugani Diane C, Chugani Harry T
Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
Epilepsia. 2004 Sep;45(9):1100-5. doi: 10.1111/j.0013-9580.2004.43303.x.
Intractable focal epilepsy is commonly associated with cortical glucose hypometabolism on interictal 2-deoxy-2[18F]-fluoro-D-glucose (FDG) positron emission tomography (PET). However, subcortical brain structures also may show hypometabolism on PET and volume changes on magnetic resonance imaging (MRI) studies, and these are less well understood in terms of their pathophysiology and clinical significance. In the present study, we analyzed alterations of glucose metabolism in subcortical nuclei and hippocampus by using FDG-PET in young patients with intractable epilepsy.
Thirty-seven patients (mean age, 7.5 years; age range, 1-27 years) with intractable frontal (n = 23) and temporal (n = 14) lobe epilepsy underwent FDG-PET scanning as part of their presurgical evaluation. Normalized glucose metabolism was measured in the thalamus and caudate and lentiform nuclei, as well as in hippocampus, both ipsi- and contralateral to the epileptic focus, and correlated with duration and age at onset of epilepsy, presence or absence of secondary generalization, location of the epileptic focus, and extent of cortical glucose hypometabolism.
Long duration of epilepsy was associated with lower glucose metabolism in the ipsilateral thalamus and hippocampus. Duration of epilepsy was a significant predictor of ipsilateral thalamic glucose metabolism in both temporal and frontal lobe epilepsy. Presence of secondarily generalized seizures also was associated with lower normalized metabolism in the ipsilateral thalamus and hippocampus. Extent of cortical hypometabolism did not correlate with subcortical metabolism, and glucose metabolism in the caudate and lentiform nuclei did not show any correlation with the clinical variables.
The findings suggest that metabolic dysfunction of the thalamus ipsilateral to the seizure focus may become more severe with long-standing temporal and frontal lobe epilepsy, and also with secondary generalization of seizures.
难治性局灶性癫痫通常与发作间期2-脱氧-2[¹⁸F]-氟-D-葡萄糖（FDG）正电子发射断层扫描（PET）显示的皮质葡萄糖代谢减低相关。然而，皮质下脑结构在PET上也可能显示代谢减低，在磁共振成像（MRI）研究中显示体积变化，而这些在病理生理学和临床意义方面的了解较少。在本研究中，我们使用FDG-PET分析了难治性癫痫年轻患者皮质下核团和海马的葡萄糖代谢改变。
37例（平均年龄7.5岁；年龄范围1至27岁）难治性额叶（n = 23）和颞叶（n = 14）癫痫患者在术前评估时接受了FDG-PET扫描。测量癫痫灶同侧和对侧丘脑、尾状核、豆状核以及海马的标准化葡萄糖代谢，并将其与癫痫发作持续时间、发病年龄、是否存在继发性全面发作、癫痫灶位置以及皮质葡萄糖代谢减低程度进行关联分析。
癫痫发作持续时间长与同侧丘脑和海马的葡萄糖代谢较低相关。癫痫发作持续时间是颞叶和额叶癫痫同侧丘脑葡萄糖代谢的重要预测指标。继发性全面发作的存在也与同侧丘脑和海马的标准化代谢较低相关。皮质代谢减低程度与皮质下代谢无关，尾状核和豆状核的葡萄糖代谢与临床变量无任何相关性。
研究结果表明，癫痫发作灶同侧丘脑的代谢功能障碍可能在长期的颞叶和额叶癫痫以及癫痫继发性全面发作时变得更加严重。
