Sperling M R, Alavi A, Reivich M, French J A, O'Connor M J
Department of Neurology, University of Pennsylvania, Philadelphia, USA.
Epilepsia. 1995 Jul;36(7):722-7. doi: 10.1111/j.1528-1157.1995.tb01052.x.
We report 2 patients in whom visual interpretation of interictal positron emission tomography (PET) with [18F]fluorodeoxyglucose (FDG) suggested false lateralization of an epileptic focus. PET scans were interpreted as showing diffuse left temporal lobe hypometabolism in 1 patient and lateral temporal hypometabolism in the other. However, seizures began in the right mesial temporal lobe in both patients, and both responded favorably to right temporal lobectomy. In 1 patient, the intracranial EEG showed continuous asymptomatic subclinical seizure activity emanating from the right amygdala. These limbic discharges probably caused unrecognized right temporal lobe hypermetabolism. In the other case, quantitative analysis of metabolic rates showed conflicting mesial and lateral metabolic indexes. Frequent mesial interictal discharges might have increased lateral temporal metabolism. We conclude that asymptomatic epileptiform activity may alter temporal lobe metabolism and that quantitative PET analysis helps clarify contradictory visual PET interpretations.
我们报告了2例患者，其发作间期[18F]氟代脱氧葡萄糖（FDG）正电子发射断层扫描（PET）的视觉解读提示癫痫病灶出现错误的定位。PET扫描结果在1例患者中被解读为左侧颞叶弥漫性代谢减低，在另1例患者中为颞叶外侧代谢减低。然而，这2例患者的癫痫发作均起始于右侧颞叶内侧，且二者均对右侧颞叶切除术反应良好。在1例患者中，颅内脑电图显示右侧杏仁核出现持续无症状的亚临床癫痫发作活动。这些边缘系统放电可能导致未被识别的右侧颞叶代谢增高。在另1例患者中，代谢率的定量分析显示内侧和外侧代谢指标相互矛盾。频繁的内侧发作间期放电可能增加了颞叶外侧的代谢。我们得出结论，无症状癫痫样活动可能会改变颞叶代谢，并且PET定量分析有助于澄清PET视觉解读中的矛盾之处。
