POSITRON EMISSION TOMOGRAPHY IN PATIENTS WITH DRUG RESISTANT TEMPORAL LOBE EPILEPSY WITH DIFFERENT ICTAL PROPAGATION PATTERNS IN SCALP EEG

Yıl 2021, Cilt: 84 Sayı: 2, 175 - 180, 25.04.2021

Nermin Görkem Şirin Bedia Marangozoğlu Ebru Yılmaz Ayşen Gökyiğit Betül Baykan Candan Gürses Nerses Bebek

https://doi.org/10.26650/IUITFD.2020.0053

Öz

Objective: In presurgical evaluation, positron emission tomography with fluorodeoxyglucose-F18 (FDG-PET) is an important tool in identifying epileptogenic area. The aim of this study was to evaluate glucose metabolism in FDG-PET in patients with temporal lobe epilepsy (TLE) showing ‘switch-of lateralisation’ (SL) and ‘bilateral asynchrony’ (BA) in ictal scalp EEG and compare their results with patients with TLE and none of these patterns. Methods: Twenty-four patients with TLE showing SL and/or BA in at least one of their seizures in video-EEG monitoring and 38 patients with TLE and without these patterns who had epilepsy surgery and a follow-up at least 5-years were included. The clinical, electrophysiological and imaging features were evaluated and a statistical comparison was performed between the groups. Results: Bilateral hypometabolism was more frequent in patients with SL and/or BA (39%) than in patients without these patterns (0%, p=0.040) in parallel with bilateral interictal epileptiform discharges and bilateral abnormalities in MRI. The presence of unilateral or bilateral hypometabolism was not related to postsurgical outcome in patients with SL and/or BA. Conclusion: The possibility of low accuracy in the lateralisation of hypometabolism in FDG-PET might be interpreted cautiously in TLE with bilateral independent ictal activity like SL and BA.

Anahtar Kelimeler

Temporal lobe epilepsy, ictal propagation patterns, switch-of lateralisation, bilateral asynchronya, FDG-PET, functional imaging

YÜZEYEL EEG’DE FARKLI İKTAL YAYILIM PATERNLERİ GÖSTEREN İLACA DİRENÇLİ TEMPORAL LOB EPİLEPSİLİ HASTALARDA POZİTRON EMİSYON TOMOGRAFİ

Öz

Amaç: Temporal lob epilepsili (TLE) hastaların cerrahi öncesi değerlendirilmesinde epileptojenik alanın belirlenmesi amacıyla yapılan flurodeoksiglukoz F 18’li positron emisyon tomografisi (FDG-PET) incelemesi önemli bilgiler sağlamaktadır. Bu çalışmada, yüzeyel iktal EEG kayıtlarında ‘switch-of lateralizasyon’ ve/veya ‘bilateral asenkroni’ izlenen TLE’li hastalarının interiktal FDG-PET incelemelerinde glukoz metabolizma verilerinin incelenmesi ve bu paternlerin izlenmediği TLE hastaları ile karşılaştırılması amaçlandı. Gereç ve Yöntem: Video-EEG monitörizasyon (VEM) incelemesinde en az bir nöbetinde ‘switch-of lateralizasyon’ ve ‘bilateral asenkroni’ saptanan 24 TLE’li hasta çalışmaya dahil edildi. Kontrol grubu olarak, bu iktal paternlerin izlenmediği, epilepsi cerrahisi geçirmiş ve 5 yıllık izlemi olan TLE hastaları belirlendi. Klinik, elektrofizyolojik ve görüntüleme bulguları değerlendirildi ve hasta grupları arasında istatistiksel olarak kıyaslandı. Bulgular: VEM’de ‘switch-of lateralizasyon’ ve/veya ‘bilateral asenkroni’ izlenen TLE’li hastalarda (%39), bu paternlerin izlenmediği gruba kıyasla (%0) FDG-PET incelemelerinde bilateral temporal hipometabolizma görülme oranı daha fazlaydı (p=0.040). Bu oran, bilateral interiktal epileptiform aktivite ve bilateral manyetik rezonans görüntülme anomalileri için de benzerdi. Opere olmuş ve VEM incelemelerinde ‘switch-of lateralizasyon’ ve/veya ‘bilateral asenkroni’ izlenen TLE’li hastalar içerisinde FDG-PET’de bilateral temporal hipometabolizma varlığı, cerrahi sonrası sonlanım açısından farklılık göstermemekteydi. Sonuç: Sonuçlarımız, cerrahi öncesi değerlendirmede VEM’de ‘switch-of lateralizasyon’ ve/veya ‘bilateral asenkroni’ izlenen TLE’li hastalarda FDG-PET bulgularının lateralizasyon değerlerinin dikkatli yorumlanması gerektiğini göstermiştir.

Anahtar Kelimeler

Temporal lob epilepsisi, iktal yayılım paternleri, switch-of lateralizasyon, bilateral asenkroni, FDG-PE, FDG-PET, fonksiyonel görüntüleme, fonksiyonel görüntüleme

Kaynakça

• 1. McIntosh AM, Kalnins RM, Mitchell LA, Fabinyi GC, Briellmann RS, Berkovic SF. Temporal lobectomy: longterm seizure outcome, late recurrence and risks for seizure recurrence. Brain 2004;127(Pt 9): 2018-30. [CrossRef]
• 2. Miller JW, Hakimian S. Surgical treatment of epilepsy. Continuum (Minneap Minn) 2013;19(3 Epilepsy):730-42. [CrossRef]
• 3. Wiebe S, Blume WT, Girvin JP, Eliasziw M, Effectiveness, Efficiency of Surgery for Temporal Lobe Epilepsy Study G. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 2001;345(5):311-8. [CrossRef]
• 4. Ryvlin P, Rheims S. Predicting epilepsy surgery outcome. Curr Opin Neurol 2016;29(2):182-8. [CrossRef]
• 5. de Tisi J, Bell GS, Peacock JL, McEvoy AW, Harkness WF, Sander JW, et al. The long-term outcome of adult epilepsy surgery, patterns of seizure remission, and relapse: a cohort study. Lancet 2011;378(9800):1388-95. [CrossRef]
• 6. Rosenow F, Bast T, Czech T, Feucht M, Hans VH, Helmstaedter C, et al. Revised version of quality guidelines for presurgical epilepsy evaluation and surgical epilepsy therapy issued by the Austrian, German, and Swiss working group on presurgical epilepsy diagnosis and operative epilepsy treatment. Epilepsia 2016;57(8):1215-20. [CrossRef]
• 7. Ergun EL, Saygi S, Yalnizoglu D, Oguz KK, Erbas B. SPECTPET in Epilepsy and Clinical Approach in Evaluation. Semin Nucl Med 2016;46(4):294-307. [CrossRef]
• 8. Theodore WH. Presurgical Focus Localization in Epilepsy: PET and SPECT. Semin Nucl Med 2017;47(1):44-53. [CrossRef]
• 9. Miletich RS. Positron Emission Tomography and Single- Photon Emission Computed Tomography in Neurology. Continuum (Minneap Minn) 2016;22(5, Neuroimaging): 1636-54. [CrossRef]
• 10. Horky LL, Treves ST. PET and SPECT in brain tumors and epilepsy. Neurosurg Clin N Am 2011;22(2):169-84. [CrossRef] 1
• 1. Capraz IY, Kurt G, Akdemir O, Hirfanoglu T, Oner Y, Sengezer T, et al. Surgical outcome in patients with MRInegative, PET-positive temporal lobe epilepsy. Seizure 2015;29:63-8. [CrossRef]
• 12. LoPinto-Khoury C, Sperling MR, Skidmore C, Nei M, Evans J, Sharan A, et al. Surgical outcome in PET-positive, MRInegative patients with temporal lobe epilepsy. Epilepsia 2012;53(2):342-8. [CrossRef]
• 13. Carne RP, O’Brien TJ, Kilpatrick CJ, MacGregor LR, Hicks RJ, Murphy MA, et al. MRI-negative PET-positive temporal lobe epilepsy: a distinct surgically remediable syndrome. Brain 2004;127(Pt 10):2276-85. [CrossRef]
• 14. Yang PF, Pei JS, Zhang HJ, Lin Q, Mei Z, Zhong ZH, et al. Long-term epilepsy surgery outcomes in patients with PETpositive, MRI-negative temporal lobe epilepsy. Epilepsy Behav 2014;41:91-7. [CrossRef]
• 15. Gok B, Jallo G, Hayeri R, Wahl R, Aygun N. The evaluation of FDG-PET imaging for epileptogenic focus localization in patients with MRI positive and MRI negative temporal lobe epilepsy. Neuroradiology 2013;55(5):541-50. [CrossRef]
• 16. Willmann O, Wennberg R, May T, Woermann FG, Pohlmann- Eden B. The contribution of 18F-FDG PET in preoperative epilepsy surgery evaluation for patients with temporal lobe epilepsy A meta-analysis. Seizure 2007;16(6):509-20. [CrossRef]
• 17. Sirin NG, Yilmaz E, Bebek N, Baykan B, Gokyigit A, Gurses C. Unusual ictal propagation patterns suggesting poor prognosis after temporal lobe epilepsy surgery: Switch of lateralization and bilateral asynchrony. Epilepsy Behav 2018;86:31-6.
• 18. Sirin NG, Gurses C, Bebek N, Dirican A, Baykan B, Gokyigit A. A quadruple examination of ictal EEG patterns in mesial temporal lobe epilepsy with hippocampal sclerosis: onset, propagation, later significant pattern, and termination. J Clin Neurophysiol 2013;30(4):329-38. [CrossRef]
• 19. Schulz R, Luders HO, Hoppe M, Tuxhorn I, May T, Ebner A. Interictal EEG and ictal scalp EEG propagation are highly predictive of surgical outcome in mesial temporal lobe epilepsy. Epilepsia 2000;41(5):564-70. [CrossRef]
• 20. Steinhoff BJ, So NK, Lim S, Luders HO. Ictal scalp EEG in temporal lobe epilepsy with unitemporal versus bitemporal interictal epileptiform discharges. Neurology 1995;45(5):889-96. [CrossRef]
• 21. Napolitano CE, Orriols MA. Graduated and sequential propagation in mesial temporal epilepsy: analysis with scalp ictal EEG. J Clin Neurophysiol 2010;27(4):285-91. [CrossRef]
• 22. Alvim MKM, Morita ME, Yasuda CL, Damasceno BP, Lopes TM, Coan AC, et al. Is inpatient ictal videoelectroencephalographic monitoring mandatory in mesial temporal lobe epilepsy with unilateral hippocampal sclerosis? A prospective study. Epilepsia 2018;59(2):410-9. [CrossRef]
• 23. Wieser HG, Blume WT, Fish D, Goldensohn E, Hufnagel A, King D, et al. ILAE Commission Report. Proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia 2001;42(2):282-6. [CrossRef]
• 24. Van Paesschen W, Dupont P, Sunaert S, Goffin K, Van Laere K. The use of SPECT and PET in routine clinical practice in epilepsy. Curr Opin Neurol 2007;20(2):194-202. [CrossRef]
• 25. von Oertzen TJ. PET and ictal SPECT can be helpful for localizing epileptic foci. Curr Opin Neurol 2018;31(2):184- 91. [CrossRef]
• 26. Bouvard S, Costes N, Bonnefoi F, Lavenne F, Mauguiere F, Delforge J, et al. Seizure-related short-term plasticity of benzodiazepine receptors in partial epilepsy: a [11C] flumazenil-PET study. Brain 2005;128(Pt6):1330-43. [CrossRef]
• 27. Benedek K, Juhasz C, Chugani DC, Muzik O, Chugani HT. Longitudinal changes in cortical glucose hypometabolism in children with intractable epilepsy. J Child Neurol 2006;21(1):26-31. [CrossRef]
• 28. Koutroumanidis M, Hennessy MJ, Seed PT, Elwes RD, Jarosz J, Morris RG, et al. Significance of interictal bilateral temporal hypometabolism in temporal lobe epilepsy. Neurology 2000;54(9):1811-21. [CrossRef]
• 29. Chassoux F, Artiges E, Semah F, Laurent A, Landre E, Turak B, et al. F-FDG-PET patterns of surgical success and failure in mesial temporal lobe epilepsy. Neurology 2017;88(11): 1045-53. [CrossRef]
• 30. Farooque P, Hirsch L, Levy S, Testa F, Mattson R, Spencer D. Surgical outcome in adolescents with mesial temporal sclerosis: Is it different? Epilepsy Behav 2017;69:24-7. [CrossRef]
• 31. Elwan S, Alexopoulos A, Silveira DC, Kotagal P. Lateralizing and localizing value of seizure semiology: Comparison with scalp EEG, MRI and PET in patients successfully treated with resective epilepsy surgery. Seizure 2018;61:203-8. [CrossRef]
• 32. Kim YK, Lee DS, Lee SK, Chung CK, Chung JK, Lee MC. (18)F-FDG PET in localization of frontal lobe epilepsy: comparison of visual and SPM analysis. J Nucl Med 2002;43(9):1167-74.
• 33. Cendes F. Neuroimaging in investigation of patients with epilepsy. Continuum (Minneap Minn) 2013;19(3 Epilepsy):623-42. [CrossRef]
• 34. Kang SY, Lee SA, Yim SB, Lim YM, Kang JK, Lee JK. Factors contributing to clinical seizure lateralization in patients with mesial temporal lobe epilepsy. Eur Neurol 2005;54(4):191-8. [CrossRef]
• 35. Okujava M, Schulz R, Hoppe M, Ebner A, Jokeit H, Woermann FG. Bilateral mesial temporal lobe epilepsy: comparison of scalp EEG and hippocampal MRI-T2 relaxometry. Acta Neurol Scand 2004;110(3):148-53. [CrossRef]
• 36. Caboclo LO, Garzon E, Oliveira PA, Carrete H, Jr., Centeno RS, Bianchin MM, et al. Correlation between temporal pole MRI abnormalities and surface ictal EEG patterns in patients with unilateral mesial temporal lobe epilepsy. Seizure 2007;16(1):8-16. [CrossRef]
• 37. Kilpatrick C, Cook M, Matkovic Z, O’Brien T, Kaye A, Murphy M. Seizure frequency and duration of epilepsy are not risk factors for postoperative seizure outcome in patients with hippocampal sclerosis. Epilepsia 1999;40(7):899-903. [CrossRef]
• 38. Spencer SS, Berg AT, Vickrey BG, Sperling MR, Bazil CW, Shinnar S, et al. Predicting long-term seizure outcome after resective epilepsy surgery: the multicenter study. Neurology 2005;65(6):912-8. [CrossRef]
• 39. Spencer S, Huh L. Outcomes of epilepsy surgery in adults and children. Lancet Neurol 2008;7(6):525-37. [CrossRef]
• 40. Janszky J, Fogarasi A, Jokeit H, Schulz R, Hoppe M, Ebner A. Spatiotemporal relationship between seizure activity and interictal spikes in temporal lobe epilepsy. Epilepsy Res 2001;47(3):179-88. [CrossRef]
• 41. Janszky J, Janszky I, Schulz R, Hoppe M, Behne F, Pannek HW, et al. Temporal lobe epilepsy with hippocampal sclerosis: predictors for long-term surgical outcome. Brain 2005;128(Pt 2):395-404. [CrossRef]
• 42. Radhakrishnan K, So EL, Silbert PL, Jack CR, Jr., Cascino GD, Sharbrough FW, et al. Predictors of outcome of anterior temporal lobectomy for intractable epilepsy: a multivariate study. Neurology 1998;51(2):465-71. [CrossRef]
• 43. Wieser HG, Ortega M, Friedman A, Yonekawa Y. Long-term seizure outcomes following amygdalohippocampectomy. J Neurosurg 2003;98(4):751-63. [CrossRef]
• 44. Gupta PC, Dharampaul, Pathak SN, Singh B. Secondary epileptogenic EEG focus in temporal lobe epilepsy. Epilepsia 1973;14(4):423-6. [CrossRef]
• 45. Morrell F. Secondary epileptogenesis in man. Arch Neurol 1985;42(4):318-35. [CrossRef]
• 46. Gollwitzer S, Scott CA, Farrell F, Bell GS, de Tisi J, Walker MC, et al. The long-term course of temporal lobe epilepsy: From unilateral to bilateral interictal epileptiform discharges in repeated video-EEG monitorings. Epilepsy Behav 2017;68:17-21. [CrossRef]
• 47. Holmes MD, Dodrill CB, Wilensky AJ, Ojemann LM, Ojemann GA. Unilateral focal preponderance of interictal epileptiform discharges as a predictor of seizure origin. Arch Neurol 1996;53(3):228-32.