Gaillard W D, Weinstein S, Conry J, Pearl P L, Fazilat S, Fazilat S, Vezina L G, Reeves-Tyer P, Theodore W H
Clinical Epilepsy Section, NINDS, Division of Intramural Research, Washington, DC, USA.
Neurology. 2007 Feb 27;68(9):655-9. doi: 10.1212/01.wnl.0000255942.25101.8d.
To study the evolution of cerebral glucose metabolism after partial seizure onset in children, and its relation to clinical variables.
Thirty-eight children had 3.4 +/-.8 (18)FDG-PET scans over 3.0 +/- 1.3 years starting within a year after their third unprovoked partial seizure. (18)FDG-PET was analyzed with a region of interest template to measure normalized metabolism in 12 paired anatomic areas. Scans with absolute asymmetry index, |AI|, greater than 0.13 in at least one cortical region other than the cerebellum were considered abnormal. Standard clinical T1- and T2-weighted MRI (1.5 T) scans were obtained.
Patients with initial normal PET (n = 28) were significantly more likely to remain in good seizure control than those with abnormal initial PET. Patients with initially normal PET scans that became abnormal had longer epilepsy duration before the first PET scan, but not greater seizure frequency, than those with PET always normal. There was no evidence for progression of hypometabolism. Patients with shorter time since last seizure and higher seizure frequency were more likely to have abnormal PET scans. Six of the seven patients whose PET scans were always abnormal had poor seizure control. Febrile seizure history did not affect PET findings. MRI was strongly predictive of initial PET results (chi(2) = 13.1; p < 0.02) but did not predict fluctuation hypometabolism. A model combining MRI and initial PET was strongly predictive of clinical course.
Initial imaging studies can help predict clinical course for children who have had at least three partial seizures. Serial FDG-PET is affected by seizure frequency and time since last seizure.
研究儿童部分性癫痫发作后脑葡萄糖代谢的演变及其与临床变量的关系。
38名儿童在第三次无诱因部分性癫痫发作后1年内开始，在3.0±1.3年的时间里进行了3.4±0.8次（18）FDG-PET扫描。使用感兴趣区域模板分析（18）FDG-PET，以测量12对解剖区域的标准化代谢。小脑以外至少一个皮质区域的绝对不对称指数|AI|大于0.13的扫描被认为是异常的。获得了标准的临床T1加权和T2加权MRI（1.5T）扫描。
初始PET正常的患者（n = 28）比初始PET异常的患者更有可能保持良好的癫痫控制。初始PET扫描正常但后来变为异常的患者，在第一次PET扫描前的癫痫病程比PET始终正常的患者更长，但癫痫发作频率并不更高。没有证据表明代谢减退会进展。自上次发作以来时间较短且癫痫发作频率较高的患者更有可能出现PET扫描异常。7名PET扫描始终异常的患者中有6名癫痫控制不佳。热性惊厥病史不影响PET结果。MRI对初始PET结果有很强的预测性（χ2 = 13.1；p < 0.02），但不能预测代谢减退的波动。结合MRI和初始PET的模型对临床病程有很强的预测性。
初始影像学研究有助于预测至少有三次部分性癫痫发作的儿童的临床病程。连续FDG-PET受癫痫发作频率和自上次发作以来的时间影响。
