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Presurgical multimodality neuroimaging in electroencephalographic lateralized temporal lobe epilepsy
Author(s) -
Knowlton Robert C.,
Laxer Kenneth D.,
Ende Gabriele,
Hawkins Randall A.,
Wong Stephen T. C.,
Matson Gerald B.,
Rowley Howard A.,
Fein George,
Weiner Michael W.
Publication year - 1997
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.410420603
Subject(s) - temporal lobe , magnetic resonance imaging , neuroimaging , positron emission tomography , epilepsy , medicine , hippocampal sclerosis , nuclear medicine , magnetic resonance spectroscopic imaging , hippocampal formation , electroencephalography , radiology , psychiatry
The purpose of this study was to compare 2hyphen;[ 18 F]fluoro‐2‐deoxy− D −glucose positron emission tomography (FDG‐PET), hippocampal volumetry (HV), T2 relaxometry, and proton magnetic resonance spectroscopic imaging ( 1 H‐MRSI) in the presurgical neuroimaging lateralization of patients with nonlesional, electroencephalogram (EEG)‐defined unilateral temporal lobe epilepsy (TLE). Twenty‐five patients were prospectively studied, along with age‐matched controls. T2 relaxometry examinations were performed in 13 patients. Comparison of FDG‐PET, HV, and 1 H‐MRSI was possible in 23 patients. FDG‐PET lateralized 87% of patients, HV 65%, N ‐acetyl aspartate (NAA)/(choline [Cho] + creatine [Cr]) 61% and [NAA] 57%. Combined HV and NAA/(Cho + Cr) results lateralized 83% of the patients, a value similar to PET. Of 10 patients with normal magnetic resonance imaging (MRI) scans, 2 were lateralized with HV, 6 with FDG‐PET, 4 with NAA/(Cho + Cr), and 3 with [NAA]. T2 relaxometry lateralized no patients without hippocampal atrophy. Bilateral abnormality was present in 29 to 33% of patients with 1 H‐MRSI measures and 17% with HV. Only hippocampal atrophy correlated with postoperative seizure‐free outcome. FDG‐PET remains the most sensitive imaging method to correlate with EEG‐lateralized TLE. Both FDG‐PET and 1 H‐MRSI can lateralize patients with normal MRI, but only the presence of relative unilateral hippocampal atrophy is predictive of seizure‐free outcome. Bilaterally abnorma; MRI and 1 H‐MRSI measures do not preclude good surgical outcome.