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...

Descripción completa

Detalles Bibliográficos
Autores principales: Tang, Yongxiang, Liao, Guang, Li, Jian, Long, Tingting, Li, Yulai, Feng, Li, Chen, Dengming, Tang, Beisha, Hu, Shuo
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