Gaillard W D, Fazilat S, White S, Malow B, Sato S, Reeves P, Herscovitch P, Theodore W H
Epilepsy Research Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
Neurology. 1995 Oct;45(10):1841-7. doi: 10.1212/wnl.45.10.1841.
We used positron emission tomography (PET) with 18F-2-deoxyglucose (FDG) and 15O water in 20 patients with complex partial seizures to compare glucose metabolism and blood flow in temporal lobe epileptic foci identified by ictal scalp-sphenoidal video-EEG telemetry. Glucose metabolism was measured 20 minutes after blood flow without moving the patient from the scanner. We also studied 11 patients with 99mTc-HMPAO single-photon emission computed tomography (SPECT). Both local cerebral metabolic rate of glucose (LCMRGlc) and regional cerebral blood flow (rCBF) were significantly decreased in temporal cortex ipsilateral to the EEG focus. However, LCMRGlc was reduced by 11.2% in inferior lateral and 11.1% in inferior mesial temporal cortex and rCBF by only 3.2% and 6.1%. The ratio of LCMRGlc to rCBF was significantly reduced in inferior lateral temporal cortex ipsilateral to the ictal focus (p < 0.009). Moreover, using standardized criteria, blinded raters found that 16 of 20 patients had focal FDG-PET hypometabolism, all in the epileptogenic region; 10 of 20 had focal 15O water PET hypoperfusion, but it was falsely lateralized in two of these 10; and five of 11 had focal 99mTc-HMPAO SPECT hypoperfusion, but it was falsely lateralized in two of these five. Our data suggest that interictal glucose metabolism and blood flow may be uncoupled in epileptogenic cortex.
我们对20例复杂部分性癫痫患者使用18F - 2 - 脱氧葡萄糖（FDG）和15O水进行正电子发射断层扫描（PET），以比较通过发作期头皮 - 蝶骨电极视频脑电图遥测确定的颞叶癫痫病灶中的葡萄糖代谢和血流情况。在血流测量后20分钟测量葡萄糖代谢，期间患者未离开扫描仪。我们还研究了11例使用99mTc - HMPAO单光子发射计算机断层扫描（SPECT）的患者。脑电图病灶同侧颞叶皮质的局部脑葡萄糖代谢率（LCMRGlc）和局部脑血流（rCBF）均显著降低。然而，下外侧颞叶皮质的LCMRGlc降低了11.2%，下内侧颞叶皮质降低了11.1%，而rCBF仅分别降低了3.2%和6.1%。发作期病灶同侧下外侧颞叶皮质的LCMRGlc与rCBF之比显著降低（p < 0.009）。此外，使用标准化标准，不知情的评估者发现，20例患者中有16例存在局灶性FDG - PET低代谢，均位于致痫区域；20例中有10例存在局灶性15O水PET低灌注，但其中2例出现错误的定位；11例中有5例存在局灶性99mTc - HMPAO SPECT低灌注，但其中2例出现错误的定位。我们的数据表明，发作间期癫痫病灶皮质中的葡萄糖代谢和血流可能出现解偶联。
