Varduhi Cahill1,2,3, Benjamin Sinclair4,5, Charles B Malpas1,5,6,7, Anne M McIntosh1,5,8, Zhibin Chen1,5, Lucy E Vivash1,5, Marie F O'Shea9, Sarah J Wilson7,9, Patricia M Desmond4, Salvatore U Berlangieri9, Rodney J Hicks10, Christopher C Rowe8,11, Andrew P Morokoff12, James A King12, Gavin C Fabinyi13, Andrew H Kaye12, Patrick Kwan1,5, Samuel F Berkovic8,9, Terence J O'Brien1,5. 1. Departments of Medicine and Neurology, Melbourne Brain Centre, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia. 2. Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, United Kingdom. 3. Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom. 4. Departments of Medicine and Radiology, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia. 5. Departments of Neuroscience and Neurology, Alfred Health, Central Clinical School, Monash University, Melbourne, Victoria, Australia. 6. Murdoch Children's Research Institute, Melbourne, Victoria, Australia. 7. Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia. 8. Epilepsy Research Centre, University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia. 9. Comprehensive Epilepsy Program, Austin Hospital, Melbourne, Victoria, Australia. 10. Peter MacCallum Cancer Centre and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia. 11. Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia. 12. Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia. 13. Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia.
Abstract
OBJECTIVE: We investigated the relationship between the interictal metabolic patterns, the extent of resection of 18 F-fluorodeoxyglucose positron emission tomography (18 FDG-PET) hypometabolism, and seizure outcomes in patients with unilateral drug-resistant mesial temporal lobe epilepsy (MTLE) following anterior temporal lobe (TL) resection. METHODS: Eighty-two patients with hippocampal sclerosis or normal magnetic resonance imaging (MRI) findings, concordant 18 FDG-PET hypometabolism, and at least 2 years of postoperative follow-up were included in this 2-center study. The hypometabolic regions in each patient were identified with reference to 20 healthy controls (p < 0.005). The resected TL volume and the volume of resected TL PET hypometabolism (TLH) were calculated from the pre- and postoperative MRI scans coregistered with interictal 18 FDG-PET. RESULTS: Striking differences in metabolic patterns were observed depending on the lateralization of the epileptogenic TL. The extent of the ipsilateral TLH was significantly greater in left MTLE patients (p < 0.001), whereas right MTLE patients had significantly higher rates of contralateral (CTL) TLH (p = 0.016). In right MTLE patients, CTL hypometabolism was the strongest predictor of an unfavorable seizure outcome, associated with a 5-fold increase in the likelihood of seizure recurrence (odds ratio [OR] = 4.90, 95% confidence interval [CI] = 1.07-22.39, p = 0.04). In left MTLE patients, greater extent of resection of ipsilateral TLH was associated with lower rates of seizure recurrence (p = 0.004) in univariate analysis; however, its predictive value did not reach statistical significance (OR = 0.96, 95% CI = 0.90-1.02, p = 0.19). INTERPRETATION: The difference in metabolic patterns depending on the lateralization of MTLE may represent distinct epileptic networks in patients with right versus left MTLE, and can guide preoperative counseling and surgical planning. Ann Neurol 2019; 1-10 ANN NEUROL 2019;85:241-250.
OBJECTIVE: We investigated the relationship between the interictal metabolic patterns, the extent of resection of 18 F-fluorodeoxyglucose positron emission tomography (18 FDG-PET) hypometabolism, and seizure outcomes in patients with unilateral drug-resistant mesial temporal lobe epilepsy (MTLE) following anterior temporal lobe (TL) resection. METHODS: Eighty-two patients with hippocampal sclerosis or normal magnetic resonance imaging (MRI) findings, concordant 18 FDG-PET hypometabolism, and at least 2 years of postoperative follow-up were included in this 2-center study. The hypometabolic regions in each patient were identified with reference to 20 healthy controls (p < 0.005). The resected TL volume and the volume of resected TL PET hypometabolism (TLH) were calculated from the pre- and postoperative MRI scans coregistered with interictal 18 FDG-PET. RESULTS: Striking differences in metabolic patterns were observed depending on the lateralization of the epileptogenic TL. The extent of the ipsilateral TLH was significantly greater in left MTLE patients (p < 0.001), whereas right MTLE patients had significantly higher rates of contralateral (CTL) TLH (p = 0.016). In right MTLE patients, CTL hypometabolism was the strongest predictor of an unfavorable seizure outcome, associated with a 5-fold increase in the likelihood of seizure recurrence (odds ratio [OR] = 4.90, 95% confidence interval [CI] = 1.07-22.39, p = 0.04). In left MTLE patients, greater extent of resection of ipsilateral TLH was associated with lower rates of seizure recurrence (p = 0.004) in univariate analysis; however, its predictive value did not reach statistical significance (OR = 0.96, 95% CI = 0.90-1.02, p = 0.19). INTERPRETATION: The difference in metabolic patterns depending on the lateralization of MTLE may represent distinct epileptic networks in patients with right versus left MTLE, and can guide preoperative counseling and surgical planning. Ann Neurol 2019; 1-10 ANN NEUROL 2019;85:241-250.
Authors: Maarten Haemels; Donatienne Van Weehaeghe; Evy Cleeren; Patrick Dupont; Johan van Loon; Tom Theys; Koen Van Laere; Wim Van Paesschen; Karolien Goffin Journal: Acta Neurol Belg Date: 2021-02-05 Impact factor: 2.396
Authors: Benjamin Sinclair; Varduhi Cahill; Jarrel Seah; Andy Kitchen; Lucy E Vivash; Zhibin Chen; Charles B Malpas; Marie F O'Shea; Patricia M Desmond; Rodney J Hicks; Andrew P Morokoff; James A King; Gavin C Fabinyi; Andrew H Kaye; Patrick Kwan; Samuel F Berkovic; Meng Law; Terence J O'Brien Journal: Epilepsia Date: 2022-03-25 Impact factor: 6.740
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