PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, MI, USA; University of Pennsylvania, School of Engineering and Applied Science, Philadelphia, PA, USA.
Department of Neurology, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA.
Epilepsy Behav. 2021 Sep;122:108185. doi: 10.1016/j.yebeh.2021.108185. Epub 2021 Jul 9.
Abnormalities of brain structures and neuronal networks have been identified in MRI studies of patients with Sudden Unexpected Death in Epilepsy (SUDEP) as well as in those at elevated risk. The goal of this study was to identify common patterns of objectively detected brain glucose metabolic abnormalities associated with SUDEP patients and those at high SUDEP risk.
Patients with refractory epilepsy (n = 78, age: 16-61 years, 44 females), who underwent comprehensive presurgical evaluation, were assessed for their risk of SUDEP using the revised SUDEP-7 inventory. From the 57 patients with low SUDEP risk, 35 were selected to match their demographic and clinical characteristics to those with high SUDEP risk (n = 21). [F]fluoro-deoxy-glucose positron emission tomography (FDG-PET) abnormalities were evaluated in the high- and low-SUDEP risk subgroups compared to FDG-PET scans of a healthy adult control group using statistical parametric mapping (SPM). Individual FDG-PET scans of 4 additional patients, who died from SUDEP, were also analyzed by SPM.
Mean SUDEP-7 score was 6.1 in the high and 2.7 in the low SUDEP risk group. MRI showed no lesion in 36 patients (64%). Statistical parametric mapping analysis of the high SUDEP risk subgroup showed bilateral medial frontal and inferior frontal hypometabolism as a common pattern. The low-risk group showed no specific common metabolic abnormalities on SPM group analysis. Individual PET scans of all 4 patients who died from SUDEP also showed bilateral frontal lobe hypometabolism.
These data show that bilateral frontal lobe involvement on FDG-PET, especially the medial and inferior frontal cortex, may be a common metabolic pattern associated with high SUDEP risk and SUDEP itself, in patients with refractory focal epilepsy.
磁共振成像（MRI）研究发现，癫痫猝死（SUDEP）患者和高危人群存在脑结构和神经元网络异常。本研究旨在确定与 SUDEP 患者和高危 SUDEP 患者相关的客观检测到的脑葡萄糖代谢异常的常见模式。
对接受全面术前评估的耐药性癫痫患者（n=78，年龄：16-61 岁，44 名女性）进行评估，使用修订后的 SUDEP-7 清单评估 SUDEP 风险。从低 SUDEP 风险的 57 名患者中，选择 35 名患者与高 SUDEP 风险的患者（n=21）匹配其人口统计学和临床特征。使用统计参数映射（SPM），比较高、低 SUDEP 风险亚组与健康成人对照组的氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）异常，评估 FDG-PET 异常。还通过 SPM 分析了另外 4 名因 SUDEP 而死亡的患者的个体 FDG-PET 扫描。
高 SUDEP 风险组的平均 SUDEP-7 评分为 6.1，低 SUDEP 风险组为 2.7。36 名患者（64%）的 MRI 无病变。高 SUDEP 风险亚组的 SPM 分析显示双侧内侧额叶和下额叶代谢低下是一种常见模式。低风险组在 SPM 组分析中未显示出特定的常见代谢异常。所有 4 名因 SUDEP 而死亡的患者的个体 PET 扫描也显示双侧额叶代谢低下。
这些数据表明，难治性局灶性癫痫患者 FDG-PET 显示双侧额叶受累，特别是内侧和下额叶皮质，可能是与高 SUDEP 风险和 SUDEP 本身相关的常见代谢模式。
