1Department of Clinical Neurological Sciences,London Health Sciences Centre,London,Ontario,Canada.
2the Department of Medical Imaging,London Health Sciences Centre,London,Ontario,Canada.
Can J Neurol Sci. 2018 Jan;45(1):30-34. doi: 10.1017/cjn.2017.244.
Presurgical localization of the epileptogenic focus is critical to successful surgery. Traditionally, localization of the epileptogenic focus depends on seizure semiology, scalp video-electroencephalography (vEEG), magnetic resonance imaging (MRI), neuropsychological assessment, and, when needed, intracranial EEG (iEEG). We aimed to explore the role of positron emission tomography (PET) in the presurgical evaluation of patients with refractory epilepsy.
A retrospective review was conducted on patients from London Health Sciences Centre (London, Ontario) with refractory epilepsy who underwent PET from September of 2011 to April of 2016. The accuracy of epileptogenic focus localization was compared between different investigative modalities (MRI, vEEG, iEEG, PET), and the outcomes were documented, including seizure freedom after surgical resection, improvement of seizure frequency, guidance for further investigations, and exclusion of patients from further evaluation. Patients who underwent surgery were followed up at 3 months and onward.
We identified 62 patients with refractory epilepsy who underwent PET. The mean age was 34 years (range=20-68). A total of 36 had concordant PET and vEEG findings: 6 had surgical resection and either became seizure-free (29.4%) or had improvement in seizure frequency (5.9%) at 3 months; 11 had surgical resection and either became seizure-free (29.4%) or had improvement in seizure frequency (35.3%) at 3 months, but required iEEG for final verification.
PET has an important role in presurgical evaluation of patients with refractory epilepsy. It may allow resection of the epileptogenic focus without the need for iEEG, guiding intracranial electrode placement for further localization of the epileptogenic focus, or exclusion of patients from further evaluation.
癫痫灶的术前定位对于手术的成功至关重要。传统上，癫痫灶的定位依赖于发作的症状学、头皮视频脑电图（vEEG）、磁共振成像（MRI）、神经心理学评估，以及必要时的颅内脑电图（iEEG）。我们旨在探讨正电子发射断层扫描（PET）在耐药性癫痫患者术前评估中的作用。
对 2011 年 9 月至 2016 年 4 月在伦敦健康科学中心（安大略省伦敦）接受 PET 的耐药性癫痫患者进行了回顾性研究。比较了不同检查方法（MRI、vEEG、iEEG、PET）对致痫灶定位的准确性，并记录了手术切除后的癫痫无发作率、癫痫发作频率的改善、进一步检查的指导以及患者是否排除进一步评估的情况。接受手术的患者在术后 3 个月及以后进行随访。
我们共确定了 62 例接受 PET 的耐药性癫痫患者。平均年龄为 34 岁（范围 20-68 岁）。共有 36 例患者的 PET 和 vEEG 结果一致：6 例患者行手术切除，3 个月时 29.4%的患者癫痫无发作，5.9%的患者癫痫发作频率改善；11 例患者行手术切除，35.3%的患者癫痫无发作，29.4%的患者癫痫发作频率改善，但需要 iEEG 进行最终验证。
PET 在耐药性癫痫患者的术前评估中具有重要作用。它可以在不需要 iEEG 的情况下切除致痫灶，指导颅内电极放置以进一步定位致痫灶，或者将患者排除在进一步评估之外。
