Université Paris Saclay-APHP, Neurophysiologie et Epileptologie, Le Kremlin Bicêtre, France.
Université Paris Saclay-APHP, Neurophysiologie et Epileptologie, Le Kremlin Bicêtre, France.
Epilepsy Res. 2021 May;172:106589. doi: 10.1016/j.eplepsyres.2021.106589. Epub 2021 Feb 18.
Interictal positron emission tomography (PET) with F-FDG has largely proved its utility in presurgical evaluation of drug-resistant epilepsies (DRE) and in the surgical outcomes. Interictal hypometabolism topography is related to the neuronal networks involved in the seizure onset zone (SOZ) and spread pathways. F-FDG PET has a good prognostic value for post-surgical outcome, especially in cases with unique focal ictal semiology and a limited extent of hypometabolism. Surprisingly few patients have similar limited ictal features but extended hypometabolism. The objective of this study is to show that stereoelectro encephalography (SEEG) provides an explanation for this large hypometabolism, which impacts the surgical strategy.
A cohort of 248 patients underwent F-FDG PET and SEEG to explore for refractory epilepsy in two close tertiary epilepsy centers between January 2009 and December 2017. From this cohort, a subset of patients was selected with extended PET metabolism despite showing unique and limited ictal features in scalp EEG. The surgical outcome of this subset of patients has been analysed with respect to their FDG-PET and SEEG to understand the relationship between PET/SEEG/ presentation and surgical outcome.
We report a series of seven patients with DRE and unique stereotyped ictal semiology but extensive F-FDG-PET hypometabolism revealing unexpected multifocal SOZ using SEEG. All SOZ were encompassed by the hypometabolic area.
Our results demonstrate the necessity of accounting for the discrepancy between limited symptoms and widespread hypometabolism which can reveal multifocal SOZ. In those patients, surgical possibilities should be considered carefully.
发作间期正电子发射断层扫描（PET）结合 F-FDG 在耐药性癫痫（DRE）的术前评估和手术结果中已被广泛证明其具有实用性。发作间期低代谢的拓扑结构与参与起始区（SOZ）和传播途径的神经元网络有关。F-FDG PET 对术后结果具有良好的预后价值，尤其是在具有独特的局灶性发作症状和有限的低代谢范围的情况下。令人惊讶的是，很少有患者具有类似的有限发作特征但扩展的低代谢。本研究的目的是表明立体脑电图（SEEG）为这种广泛的低代谢提供了解释，这会影响手术策略。
在 2009 年 1 月至 2017 年 12 月期间，两个密切的三级癫痫中心的 248 名患者接受了 F-FDG PET 和 SEEG 检查以探索难治性癫痫。从该队列中，选择了一组患者，尽管在头皮 EEG 中显示出独特和有限的发作特征，但 PET 代谢仍广泛扩展。分析了这组患者的手术结果，涉及他们的 FDG-PET 和 SEEG，以了解 PET/SEEG/表现与手术结果之间的关系。
我们报告了 7 例 DRE 患者，他们具有独特的刻板性发作症状学，但广泛的 F-FDG-PET 低代谢，使用 SEEG 揭示了意想不到的多灶性 SOZ。所有 SOZ 均包含在低代谢区域内。
我们的结果表明，有必要考虑到有限的症状与广泛的低代谢之间的差异，这可能会揭示多灶性 SOZ。在这些患者中，应仔细考虑手术的可能性。
