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FDG-PET and MRI in temporal lobe epilepsy: relationship to febrile seizures, hippocampal sclerosis and outcome
V Salanova1, O Markand, R Worth
1Department of Neurology, Indiana University School of Medicine, Indianapolis 46202, USA.
Objective:
To correlate the volumetric head magnetic resonance imaging (MRI) and fluorodeoxyglucose-positron emission tomography (FDG-PET) scan findings with the history, intracarotid amobarbital procedure, pathology, and outcome in patients with medically refractory temporal lobe epilepsy.
Material And Methods:
Thirty-eight patients with temporal lobe epilepsy treated surgically following a comprehensive presurgical evaluation. Follow-up ranged from 12 to 44 months.
Results:
Volumetric MRI showed ipsilateral hippocampal atrophy in 29 (76%), and PET scan showed ipsilateral temporal hypometabolism (PET-TH) in 31 (81.5%) of patients. Eighty-three percent of those patients with hippocampal sclerosis on MRI (MRI-HS) had ipsilateral PET-TH. Sixty-six percent of patients with MRI-HS had a history of prolonged febrile convulsions or a childhood febrile illness accompanied by convulsions, and 77% of patients with MRI-HS had pathologically proven hippocampal sclerosis (HS). Ninety percent became seizure free or had rare seizures.
Conclusion:
FDG-PET scans and head MRIs were complementary; 95% of patients had either MRI-HS or temporal hypometabolism. MRI-HS correlated with a history of febrile seizures and pathologically demonstrated hippocampal sclerosis. Ninety-three percent of patients had focal functional deficits on the epileptogenic side. Concordance between PET temporal hypometabolism and MRI-HS correlated with better outcome.
Insights
Head MRI and FDG-PET scans effectively identified abnormalities in temporal lobe epilepsy patients. Concordance between MRI findings and PET scans predicted better seizure control after surgery.
Area of Science:
- Neurology
- Radiology
- Epileptology
Background:
- Medically refractory temporal lobe epilepsy (TLE) poses significant treatment challenges.
- Accurate presurgical evaluation is crucial for surgical success in TLE.
Purpose of the Study:
- To correlate volumetric head MRI and FDG-PET findings with clinical, pathological, and outcome data in TLE patients.
- To assess the complementary roles of MRI and PET in TLE presurgical evaluation.
Main Methods:
- Retrospective analysis of 38 TLE patients undergoing surgical treatment.
- Correlation of volumetric MRI and FDG-PET findings with patient history, pathology, and surgical outcomes.
Main Results:
- Ipsilateral hippocampal atrophy on MRI (76%) and temporal hypometabolism on PET (81.5%) were common findings.
- MRI-defined hippocampal sclerosis (MRI-HS) correlated with history of febrile seizures and confirmed pathology.
- 90% of patients achieved seizure freedom or rare seizures post-surgery.
Conclusions:
- Head MRI and FDG-PET are complementary tools for TLE evaluation, with 95% showing abnormalities on at least one modality.
- MRI-HS correlated with specific patient history and pathological findings.
- Concordance between PET hypometabolism and MRI-HS predicted a better surgical outcome.