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Metabolic scoring in autoimmune epilepsy—Should APE scores be modified?
Author(s) -
Tripathi Madhavi,
Thankarajan Arun Raj Sreedharan,
Ihtisham Kavish,
Garg Ajay,
Vibha Deepti,
Singh Rajesh,
Ramanujam Bhargavi,
Varsi Ela,
Bal Chandrasekhar,
Tripathi Manjari
Publication year - 2021
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.13346
Subject(s) - epilepsy , medicine , autoimmune disease , psychology , psychiatry , disease
Objective We evaluate the potential utility of F‐18 FDG‐PET in addition to MRI in the diagnostic work‐up of patients with autoimmune epilepsy (AE) and propose the inclusion of functional imaging in the antibody prevalence in epilepsy (APE) scoring system. Methods This was a retrospective analysis in 60 patients, diagnosed and treated for AE, of whom 40 were antibody negative (presumed AE) and 20 were antibody positive (definitive AE). All patients had undergone a dedicated brain and whole body FDG‐PET in the department of Nuclear Medicine. Results In the antibody negative group, MRI supported a diagnosis of AE in 23 patients. Both MRI and PET were indicative in 12 cases, and standalone PET was positive in 8. While MRI alone was diagnostic in 57% (23/40), the combined yield of both modalities was 77% (31/40). When PET scores were added to assign the APE score in MRI negative cases, average APE score was 5.4. In the antibody positive group, MRI supported the diagnosis of AE in 7 patients. Both MRI and PET were positive in 4 patients and standalone PET was positive in 5 patients. While MRI alone was diagnostic in 35% (7/20), the combined yield of both modalities was 60% (12/20). When PET scores were added to assign the APE score in MRI negative cases, average APE score was 6.1. Conclusion The inclusion of metabolic information from PET distinctly improved (the sensitivity of) APE scores to predict autoimmune origin even in antibody negative cases. A larger prospective study of similar type could justify adoption of FDG‐PET into the standard diagnostic procedure.