Document Detail


The prognostic value of [F]FDG-PET in nonrefractory partial epilepsy.
MedLine Citation:
PMID:  16190939     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Regional abnormalities of cerebral glucose metabolism, as identified by 18-fluorodeoxyglucose positron emission tomography (FDG-PET) have prognostic value regarding the outcome of epilepsy surgery in patients with refractory partial epilepsy. The value of FDG-PET abnormalities in nonrefractory patients has not been investigated systematically. This study examines whether FDG-PET could be used for early identification of nonrefractory epilepsy in patients who will become pharmacoresistant later during the course of their disease. METHODS: We investigated interictal abnormalities of cerebral glucose metabolism by using FDG-PET in 125 consecutive patients with nonrefractory cryptogenic partial epilepsy and normal cranial magnetic resonance imaging (MRI), and we compared relative changes in seizure frequency in 90 patients after > or =2 years of follow-up. RESULTS: Regional asymmetry of tracer distribution was seen in 43 of the 90 patients. Forty-one patients had regional glucose hypometabolism in the temporal and two patients in an extratemporal region. No difference between patients with and without a hypometabolic focus was found regarding seizure freedom after follow-up. This held true also for the subgroup of patients with epilepsy onset within 1 year before admission. Only patients with regional glucose metabolism showed an increase in seizure frequency. Multivariate analysis showed that only anticonvulsive treatment before index admission and the possibility of localizing the epileptogenic focus by using all available clinical and EEG data were independently associated with continuing seizures after a median follow-up period of 43 months. CONCLUSIONS: Regional hypometabolism in FDG-PET is not significantly associated with a lower likelihood of successful anticonvulsant drug therapy in patients with nonrefractory partial epilepsy. Careful analysis of all routinely available clinical and neurophysiologic data has a much better predictive power to identify patients with medically refractory epilepsy early in the course of the disease. However, if PET data are available, they could help in identifying patients with a less benign course.
Authors:
Lars Weitemeyer; Christoph Kellinghaus; Matthias Weckesser; Peter Matheja; Tobias Loddenkemper; Gerhard Schuierer; Otmar Schober; E Bernd Ringelstein; Peter Lüdemann
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Epilepsia     Volume:  46     ISSN:  0013-9580     ISO Abbreviation:  Epilepsia     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-09-29     Completed Date:  2005-10-31     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  2983306R     Medline TA:  Epilepsia     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1654-60     Citation Subset:  IM    
Affiliation:
Department of Neurology, University of Münster, Münster, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Anticonvulsants / therapeutic use
Brain / metabolism,  radionuclide imaging*
Drug Resistance
Electroencephalography / statistics & numerical data
Epilepsies, Partial / diagnosis,  drug therapy*,  radionuclide imaging*
Female
Fluorodeoxyglucose F18 / diagnostic use*,  metabolism
Follow-Up Studies
Glucose / metabolism
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Multivariate Analysis
Neuropsychological Tests
Positron-Emission Tomography / statistics & numerical data*
Predictive Value of Tests
Prognosis
Temporal Lobe / metabolism,  radionuclide imaging
Tissue Distribution
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticonvulsants; 50-99-7/Glucose; 63503-12-8/Fluorodeoxyglucose F18

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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