Cargando…
FDG-PET Profiles of Extratemporal Metabolism as a Predictor of Surgical Failure in Temporal Lobe Epilepsy
Objective: Metabolic abnormality in the extratemporal area on fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) is not an uncommon finding in drug-resistant temporal lobe epilepsy (TLE), however the correlation between extratemporal metabolic abnormalities and surgical long-term...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793721/ https://www.ncbi.nlm.nih.gov/pubmed/33425950 http://dx.doi.org/10.3389/fmed.2020.605002 |
_version_ | 1783634049664811008 |
---|---|
author | Tang, Yongxiang Liao, Guang Li, Jian Long, Tingting Li, Yulai Feng, Li Chen, Dengming Tang, Beisha Hu, Shuo |
author_facet | Tang, Yongxiang Liao, Guang Li, Jian Long, Tingting Li, Yulai Feng, Li Chen, Dengming Tang, Beisha Hu, Shuo |
author_sort | Tang, Yongxiang |
collection | PubMed |
description | Objective: Metabolic abnormality in the extratemporal area on fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) is not an uncommon finding in drug-resistant temporal lobe epilepsy (TLE), however the correlation between extratemporal metabolic abnormalities and surgical long-term prognosis has not been fully elucidated. We aim to investigate FDG-PET extratemporal metabolic profiles predictive of failure in surgery for TLE patients. Methods: Eighty-two patients with unilateral TLE (48 female, 34 male; 25.6 ± 10.6 years old; 37 left TLE, 45 right TLE) and 30 healthy age-matched controls were enrolled. Patients were classified either as experiencing seizure-recurrence (SZR, Engel class II through IV) or seizure-free (SZF, Engel class I) at least 1 year after surgery. Regional cerebral metabolism was evaluated by FDG-PET with statistical parametric mapping (SPM12). Abnormal metabolic profiles and patterns on FDG-PET in SZR group were evaluated and compared with those of healthy control and SZF subjects on SPM12. Volume and intensity as well as special brain areas of abnormal metabolism in temporal and extratemporal regions were quantified and visualized. Results: With a median follow-up of 1.5 years, 60% of patients achieved Engel class I (SZF). SZR was associated with left TLE and widespread hypometabolism in FDG-PET visual assessment (both p < 0.05). All patients had hypometabolism in the ipsilateral temporal lobe but SZR was not correlated with volume or intensity of temporal hypometabolism (median, 1,456 vs. 1,040 mm(3); p > 0.05). SZR was correlated with extratemporal metabolic abnormalities that differed according to lateralization: in right TLE, SZR exhibited larger volume in extratemporal areas compared to SZF (median, 11,060 vs. 2,112 mm(3); p < 0.05). Surgical failure was characterized by Cingulum_Ant_R/L, Frontal_Inf_Orb_R abnormal metabolism in extratemporal regions. In left TLE, SZR presented a larger involvement of extratemporal areas similar to right TLE but with no significant (median, 5,873 vs. 3,464 mm(3); p > 0.05), Cingulum_Ant_ R/L, Parietal_Inf_L, Postcentral_L, and Precuneus_R involved metabolic abnormalities were correlated with SZR. Conclusions: Extratemporal metabolic profiles detected by FDG-PET may indicate a prominent cause of TLE surgery failure and should be considered in predictive models for epilepsy surgery. Seizure control after surgery might be improved by investigating extratemporal areas as candidates for resection or neuromodulation. |
format | Online Article Text |
id | pubmed-7793721 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-77937212021-01-09 FDG-PET Profiles of Extratemporal Metabolism as a Predictor of Surgical Failure in Temporal Lobe Epilepsy Tang, Yongxiang Liao, Guang Li, Jian Long, Tingting Li, Yulai Feng, Li Chen, Dengming Tang, Beisha Hu, Shuo Front Med (Lausanne) Medicine Objective: Metabolic abnormality in the extratemporal area on fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) is not an uncommon finding in drug-resistant temporal lobe epilepsy (TLE), however the correlation between extratemporal metabolic abnormalities and surgical long-term prognosis has not been fully elucidated. We aim to investigate FDG-PET extratemporal metabolic profiles predictive of failure in surgery for TLE patients. Methods: Eighty-two patients with unilateral TLE (48 female, 34 male; 25.6 ± 10.6 years old; 37 left TLE, 45 right TLE) and 30 healthy age-matched controls were enrolled. Patients were classified either as experiencing seizure-recurrence (SZR, Engel class II through IV) or seizure-free (SZF, Engel class I) at least 1 year after surgery. Regional cerebral metabolism was evaluated by FDG-PET with statistical parametric mapping (SPM12). Abnormal metabolic profiles and patterns on FDG-PET in SZR group were evaluated and compared with those of healthy control and SZF subjects on SPM12. Volume and intensity as well as special brain areas of abnormal metabolism in temporal and extratemporal regions were quantified and visualized. Results: With a median follow-up of 1.5 years, 60% of patients achieved Engel class I (SZF). SZR was associated with left TLE and widespread hypometabolism in FDG-PET visual assessment (both p < 0.05). All patients had hypometabolism in the ipsilateral temporal lobe but SZR was not correlated with volume or intensity of temporal hypometabolism (median, 1,456 vs. 1,040 mm(3); p > 0.05). SZR was correlated with extratemporal metabolic abnormalities that differed according to lateralization: in right TLE, SZR exhibited larger volume in extratemporal areas compared to SZF (median, 11,060 vs. 2,112 mm(3); p < 0.05). Surgical failure was characterized by Cingulum_Ant_R/L, Frontal_Inf_Orb_R abnormal metabolism in extratemporal regions. In left TLE, SZR presented a larger involvement of extratemporal areas similar to right TLE but with no significant (median, 5,873 vs. 3,464 mm(3); p > 0.05), Cingulum_Ant_ R/L, Parietal_Inf_L, Postcentral_L, and Precuneus_R involved metabolic abnormalities were correlated with SZR. Conclusions: Extratemporal metabolic profiles detected by FDG-PET may indicate a prominent cause of TLE surgery failure and should be considered in predictive models for epilepsy surgery. Seizure control after surgery might be improved by investigating extratemporal areas as candidates for resection or neuromodulation. Frontiers Media S.A. 2020-12-14 /pmc/articles/PMC7793721/ /pubmed/33425950 http://dx.doi.org/10.3389/fmed.2020.605002 Text en Copyright © 2020 Tang, Liao, Li, Long, Li, Feng, Chen, Tang and Hu. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Medicine Tang, Yongxiang Liao, Guang Li, Jian Long, Tingting Li, Yulai Feng, Li Chen, Dengming Tang, Beisha Hu, Shuo FDG-PET Profiles of Extratemporal Metabolism as a Predictor of Surgical Failure in Temporal Lobe Epilepsy |
title | FDG-PET Profiles of Extratemporal Metabolism as a Predictor of Surgical Failure in Temporal Lobe Epilepsy |
title_full | FDG-PET Profiles of Extratemporal Metabolism as a Predictor of Surgical Failure in Temporal Lobe Epilepsy |
title_fullStr | FDG-PET Profiles of Extratemporal Metabolism as a Predictor of Surgical Failure in Temporal Lobe Epilepsy |
title_full_unstemmed | FDG-PET Profiles of Extratemporal Metabolism as a Predictor of Surgical Failure in Temporal Lobe Epilepsy |
title_short | FDG-PET Profiles of Extratemporal Metabolism as a Predictor of Surgical Failure in Temporal Lobe Epilepsy |
title_sort | fdg-pet profiles of extratemporal metabolism as a predictor of surgical failure in temporal lobe epilepsy |
topic | Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793721/ https://www.ncbi.nlm.nih.gov/pubmed/33425950 http://dx.doi.org/10.3389/fmed.2020.605002 |
work_keys_str_mv | AT tangyongxiang fdgpetprofilesofextratemporalmetabolismasapredictorofsurgicalfailureintemporallobeepilepsy AT liaoguang fdgpetprofilesofextratemporalmetabolismasapredictorofsurgicalfailureintemporallobeepilepsy AT lijian fdgpetprofilesofextratemporalmetabolismasapredictorofsurgicalfailureintemporallobeepilepsy AT longtingting fdgpetprofilesofextratemporalmetabolismasapredictorofsurgicalfailureintemporallobeepilepsy AT liyulai fdgpetprofilesofextratemporalmetabolismasapredictorofsurgicalfailureintemporallobeepilepsy AT fengli fdgpetprofilesofextratemporalmetabolismasapredictorofsurgicalfailureintemporallobeepilepsy AT chendengming fdgpetprofilesofextratemporalmetabolismasapredictorofsurgicalfailureintemporallobeepilepsy AT tangbeisha fdgpetprofilesofextratemporalmetabolismasapredictorofsurgicalfailureintemporallobeepilepsy AT hushuo fdgpetprofilesofextratemporalmetabolismasapredictorofsurgicalfailureintemporallobeepilepsy |