Hajek M, Wieser H G, Khan N, Antonini A, Schrott P R, Maguire P, Beer H F, Leenders K L
Neurological Department, University Hospital, Zürich, Switzerland.
Neurology. 1994 Nov;44(11):2125-32. doi: 10.1212/wnl.44.11.2125.
We have studied 25 patients with interictal 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) before and after selective surgery for temporal lobe epilepsy (TLE). Based on the findings of the presurgical evaluation, including ictal intracranial EEGs, histopathologic findings, and the postoperative outcome, we classified the patients in three subgroups: (1) patients with TLE of lateral temporal origin (n = 5), (2) patients with mesiobasal limbic TLE associated with mesial gliosis (n = 14), and (3) patients with mesiobasal limbic TLE and small mesial tumors (n = 6). Postoperatively, patients with mesiobasal limbic TLE and mesial gliosis and five of six patients with mesiobasal limbic TLE and mesial tumors were seizure-free; the remaining sixth patient had one generalized seizure. Patients with TLE of lateral temporal origin had more than 90% reduction of seizure frequency. The main postoperative metabolic findings were as follows: (1) marked increase of regional cerebral metabolic rate of glucose (rCMRglu), both in the ipsilateral and, significantly, in the contralateral hemisphere in patients with mesiobasal limbic TLE and mesial gliosis-the changes of brain metabolism were characteristic for patients with the syndrome of "mesial temporal lobe epilepsy" (MTLE); (2) decrease of rCMRglu values in the contralateral mesiobasal temporal lobe (TL) cortex in all patient groups--the reduction of rCMRglu in homologous brain structures contralateral to the operated side provides evidence for stronger interhemispheric connections between both mesial TL structures than were hitherto supposed; and (3) a trend toward a normalization of rCMRglu values in the ipsilateral temporal neocortex 12 months after surgery in patients with MTLE syndrome.
我们对25例颞叶癫痫（TLE）患者在选择性手术前后进行了发作间期18F-氟脱氧葡萄糖（18F-FDG）正电子发射断层扫描（PET）研究。根据术前评估结果，包括发作期颅内脑电图、组织病理学发现及术后结果，我们将患者分为三个亚组：（1）外侧颞叶起源的TLE患者（n = 5）；（2）伴有内侧胶质增生的内侧基底边缘性TLE患者（n = 14）；（3）伴有内侧小肿瘤的内侧基底边缘性TLE患者（n = 6）。术后，伴有内侧胶质增生的内侧基底边缘性TLE患者以及6例伴有内侧肿瘤的内侧基底边缘性TLE患者中的5例无癫痫发作；其余第6例患者有1次全身性发作。外侧颞叶起源的TLE患者癫痫发作频率降低超过90%。术后主要代谢结果如下：（1）伴有内侧胶质增生的内侧基底边缘性TLE患者同侧及对侧半球局部脑葡萄糖代谢率（rCMRglu）显著增加——脑代谢变化是“内侧颞叶癫痫”（MTLE）综合征患者的特征；（2）所有患者组对侧内侧基底颞叶（TL）皮质rCMRglu值降低——手术侧对侧同源脑结构中rCMRglu的降低为内侧TL结构之间比以往认为的更强的半球间连接提供了证据；（3）MTLE综合征患者术后12个月同侧颞叶新皮质rCMRglu值有恢复正常的趋势。
