Joo Eun Yeon, Hong Seung Bong, Han Hyun Jung, Tae Woo Suk, Kim Jee Hyun, Han Sun Jung, Seo Dae Won, Lee Kyung-Han, Hong Seung-Chyul, Lee Munhyang, Kim Seunghwan, Kim Byung Tae
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-Gu, Seoul, Korea.
Brain. 2005 Aug;128(Pt 8):1802-10. doi: 10.1093/brain/awh534. Epub 2005 May 4.
To investigate postoperative changes in the cerebral glucose metabolism of patients with mesial temporal lobe epilepsy (MTLE), statistical parametric mapping (SPM) analysis was performed on pre- and postoperative (18)F-fluorodeoxyglucose PET (FDG-PET) images. We included 28 patients with MTLE who had undergone surgery and had been seizure-free postoperatively (16 had left MTLE and 12 right MTLE). All patients showed hippocampal sclerosis by pathology or brain MRI. FDG-PET images of the 12 right temporal lobe epilepsy patients were reversed to lateralize the epileptogenic zone to the left side in all patients. Application of the paired t-test in SPM to pre- and postoperative FDG-PETs showed that postoperative glucose metabolism decreased in the caudate nucleus, the pulvinar of the thalamus, fusiform gyrus, lingual gyrus and the posterior region of the insular cortex in the hemisphere ipsilateral to resection, whereas postoperative glucose metabolism increased in the anterior region of the insular cortex, temporal stem white matter, midbrain, inferior precentral gyrus, anterior cingulate gyrus and supramarginal gyrus in the hemisphere ipsilateral to resection. No significant postsurgical changes in cerebral glucose metabolism occurred in the contralateral hemisphere. Subtraction between pre- and postoperative FDG-PET images in individual patients produced similar findings to the SPM results, and additionally showed that postoperative glucose metabolism increased in the anterior thalamus in 12/28 patients (42.8%). SISCOM (subtraction ictal-interictal SPECT co-registered to MRI) performed in 17 patients showed ictal hyperperfusion in the ipsilateral temporal lobe, including the temporal stem white matter, midbrain, insular cortex and cingulate gyrus, bilateral basal ganglia and thalami, and multiple small regions in the frontoparietal lobes during seizures. This study suggests that brain regions showing a postoperative increase in glucose metabolism appear to represent the propagation pathways of ictal and interictal epileptic discharges in MTLE, whereas the postoperative decrease in glucose metabolism may be related to a permanent loss of afferents from resected anterior-mesial temporal structures.
为研究内侧颞叶癫痫（MTLE）患者术后脑葡萄糖代谢的变化，对术前和术后的（18）F-氟脱氧葡萄糖PET（FDG-PET）图像进行了统计参数映射（SPM）分析。我们纳入了28例接受手术且术后无癫痫发作的MTLE患者（16例为左侧MTLE，12例为右侧MTLE）。所有患者经病理或脑部MRI检查均显示海马硬化。将12例右侧颞叶癫痫患者的FDG-PET图像进行翻转，以使所有患者的致痫区定位于左侧。在SPM中对术前和术后的FDG-PET进行配对t检验，结果显示，在切除侧半球，术后尾状核、丘脑枕、梭状回、舌回及岛叶皮质后部的葡萄糖代谢降低，而切除侧半球岛叶皮质前部、颞叶干白质、中脑、中央前回下部、前扣带回及缘上回的葡萄糖代谢增加。对侧半球术后脑葡萄糖代谢无显著变化。个体患者术前和术后FDG-PET图像相减得出的结果与SPM结果相似，此外还显示，12/28例患者（42.8%）术后丘脑前部的葡萄糖代谢增加。对17例患者进行的SISCOM（发作期-发作间期SPECT与MRI配准相减）显示，发作期间同侧颞叶存在发作期血流灌注增加，包括颞叶干白质、中脑、岛叶皮质和扣带回，双侧基底神经节和丘脑，以及额顶叶的多个小区域。本研究提示，术后葡萄糖代谢增加的脑区似乎代表了MTLE发作期和发作间期癫痫放电的传播途径，而术后葡萄糖代谢降低可能与切除的前内侧颞叶结构传入神经的永久性丧失有关。
