Chandra P S, Vaghania Gaurang, Bal Chandra Sekhar, Tripathi Madhavi, Kuruwale Nilesh, Arora Amit, Garg Ajay, Sarkar Chitra, Diwedi Rekha, Malviya Shrividya, Padma Vasantha, Tripathi Manjari
Department of Neurosurgery, CN Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Epilepsy Res. 2014 Dec;108(10):1782-9. doi: 10.1016/j.eplepsyres.2014.09.024. Epub 2014 Sep 28.
F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) and ictally subtracted single photon emission tomography (iSPECT) are important for localizing the epileptogenic focus. The following study analyzes the role of inter-concordance between FDG-PET and iSPECT in predicting long-term outcomes after epilepsy surgery.
We prospectively evaluated (January 2003-January 2008) patients undergoing surgery for temporal or extratemporal drug refractory epilepsy (DRE) who had at least a 5 years follow up. Patients with MRI and video EEG (vEEG) concordance for the seizure focus underwent iSPECT and FDG-PET. Concordance of the iSPECT and FDG-PET with each other and with the substrate (defined by MRI and vEEG) for temporal and extra-temporal epilepsies was evaluated and correlated with outcomes.
One hundred twenty-three patients (74 males) were included in the study (mean age at time of surgery: 18.9±10.41 years). The mean age of onset of seizures was 9.87±8.37 years. The most common semiology was complex partial (45%). When both FDG-PET and iSPECT were concordant with each other, this translated into a (class I Engel at 5 years) outcome of 62% for extra-temporal epilepsies (provided they were also concordant with the lesion, as defined by MRI and vEEG). This percentage was significant (p<0.01) compared with all other situations (both FDG-PET/iSPECT not concordant to MRI/vEEG, only PET or iSPECT concordant with MRI/vEEG). This correlation was not found for the temporal epilepsies, where the MRI and vEEG were the most important prognostic parameters. In both temporal and extratemporal epilepsies the concordance of the iSPECT/FDG-PET with the MRI/vEEG correlated with a better 5-year outcome (temporal: 70% vs 25%; extra-temporal: 62% vs 33%; p<0.05).
Concordance between non-invasive investigations iSPECT and FDG-PET is an important predictive factor for surgical outcomes in extra-temporal epilepsy.
F-18氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）和发作期减影单光子发射断层扫描（iSPECT）对于癫痫病灶的定位很重要。以下研究分析了FDG-PET和iSPECT之间的一致性在预测癫痫手术后长期预后中的作用。
我们前瞻性评估了（2003年1月至2008年1月）因颞叶或颞外药物难治性癫痫（DRE）接受手术且至少随访5年的患者。癫痫病灶在MRI和视频脑电图（vEEG）上表现一致的患者接受了iSPECT和FDG-PET检查。评估了iSPECT和FDG-PET之间以及它们与颞叶和颞外癫痫的病灶（由MRI和vEEG定义）之间的一致性，并将其与预后相关联。
123例患者（74例男性）纳入研究（手术时平均年龄：18.9±10.41岁）。癫痫发作的平均起病年龄为9.87±8.37岁。最常见的发作形式是复杂部分性发作（45%）。当FDG-PET和iSPECT相互一致时，对于颞外癫痫，这转化为5年时（I级恩格尔分级）的预后为62%（前提是它们也与MRI和vEEG定义的病灶一致）。与所有其他情况（FDG-PET/iSPECT与MRI/vEEG均不一致、仅PET或iSPECT与MRI/vEEG一致）相比，该百分比具有显著性（p<0.01）。对于颞叶癫痫未发现这种相关性，其中MRI和vEEG是最重要的预后参数。在颞叶和颞外癫痫中，iSPECT/FDG-PET与MRI/vEEG之间的一致性与更好的5年预后相关（颞叶：70%对25%；颞外：62%对33%；p<0.05）。
非侵入性检查iSPECT和FDG-PET之间的一致性是颞外癫痫手术预后的重要预测因素。
