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Complex partial seizures. Correlation of clinical and metabolic features
M D Holmes1, K Kelly, W H Theodore
1Clinical Epilepsy Section, Institute of Neurological and Communicative Disorders and Stroke, Bethesda, Md 20892.
Archives of Neurology
|November 1, 1988
Summary
18F-2-deoxyglucose positron emission tomography (PET) reveals metabolic patterns in complex partial seizures. Multilobar hypometabolism prolonged seizures, while frontal hypometabolism shortened them, but PET struggled to differentiate frontal from temporal origins in some cases.
Area of Science:
- Neurology
- Nuclear Medicine
- Epilepsy Research
Background:
- Complex partial seizures (CPS) are challenging to localize.
- 18F-2-deoxyglucose positron emission tomography (FDG-PET) assesses regional cerebral metabolism.
- Simultaneous electroencephalography (EEG) and closed-circuit television (CCTV) capture ictal events.
Purpose of the Study:
- To compare metabolic patterns identified by FDG-PET with ictal semiology and EEG findings in patients with CPS.
- To investigate the relationship between the location and extent of hypometabolism and seizure characteristics.
Main Methods:
- 48 patients with CPS underwent simultaneous EEG, CCTV, and FDG-PET.
- PET scans were analyzed for patterns of hypometabolism (unilateral temporal, frontal, frontotemporal, frontoparietal, temporoparietal, or widespread).
- EEG/CCTV data and PET findings were scored by blinded raters.
Main Results:
- 26 patients had unilateral temporal hypometabolism; 3, frontal; 10, ipsilateral frontotemporal; 1, frontoparietal; 5, temporoparietal; and 3, widespread hypometabolism.
- Frontal hypometabolism alone correlated with shorter ictal/postictal durations.
- Multilobar hypometabolism was associated with prolonged seizures.
- Auras were more common with temporal hypometabolism; motionless stare was not a distinguishing feature.
- Specific metabolic patterns did not consistently predict other ictal clinical features like vocalizations.
Conclusions:
- FDG-PET can identify regional hypometabolism in CPS, with distinct patterns observed.
- The extent of hypometabolism influences seizure duration, with multilobar involvement prolonging seizures.
- While temporal hypometabolism is linked to auras, differentiating frontal from temporal lobe CPS using PET can be difficult when hypometabolism is widespread.