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Carvalho MS, Alvim MKM, Etchebehere E, Santos ADO, Ramos CD, Argenton JLP, Cendes F, Amorim BJ. Interictal and postictal 18F-FDG PET/CT in epileptogenic zone localization. Radiol Bras 2022; 55:273-279. [PMID: 36320375 PMCID: PMC9620847 DOI: 10.1590/0100-3984.2021.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the performance of 18F-fluorodeoxyglucose
positron-emission tomography/computed tomography ( 18F-FDG
PET/CT) in localizing epileptogenic zones, comparing 18F-FDG
injection performed in the traditional interictal period with that performed
near the time of a seizure. Materials and Methods We evaluated patients with refractory epilepsy who underwent
18F-FDG PET/CT. The reference standards for localization of the
epileptogenic zone were histopathology and follow-up examinations (in
patients who underwent surgery) or serial electroencephalography (EEG)
recordings, long-term video EEG, and magnetic resonance imaging (in patients
who did not). The 18F-FDG injection was performed whether the
patient had an epileptic seizure during the EEG monitoring period or not.
The 18F-FDG PET/CT results were categorized as concordant or
discordant with the reference standards. Results Of the 110 patients evaluated, 10 were in a postictal group (FDG injection
after a seizure) and 100 were in the interictal group. The
18F-FDG PET/CT was concordant with the reference standards in
nine (90%) of the postictal group patients and in 60 (60%) of the interictal
group patients. Among the nine postictal group patients in whom the results
were concordant, the 18F-FDG PET/CT showed hypermetabolism and
hypometabolism in the epileptogenic zone in four (44.4%) and five (55.6%),
respectively. Conclusion Our data indicate that 18F-FDG PET/CT is a helpful tool for
localization of the epileptogenic zone and that EEG monitoring is an
important means of correlating the findings. In addition, postictal
18F-FDG PET/CT is able to identify the epileptogenic zone by
showing either hypometabolism or hypermetabolism.
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van Heumen S, Moreau JT, Simard-Tremblay E, Albrecht S, Dudley RWR, Baillet S. Case Report: Aperiodic Fluctuations of Neural Activity in the Ictal MEG of a Child With Drug-Resistant Fronto-Temporal Epilepsy. Front Hum Neurosci 2021; 15:646426. [PMID: 33746727 PMCID: PMC7969518 DOI: 10.3389/fnhum.2021.646426] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/12/2021] [Indexed: 11/24/2022] Open
Abstract
Successful surgical treatment of patients with focal drug-resistant epilepsy remains challenging, especially in cases for which it is difficult to define the area of cortex from which seizures originate, the seizure onset zone (SOZ). Various diagnostic methods are needed to select surgical candidates and determine the extent of resection. Interictal magnetoencephalography (MEG) with source imaging has proven to be useful for presurgical evaluation, but the use of ictal MEG data remains limited. The purpose of the present study was to determine whether pre-ictal variations of spectral properties of neural activity from ictal MEG recordings are predictive of SOZ location.We performed a 4 h overnight MEG recording in an 8-year-old child with drug-resistant focal epilepsy of suspected right fronto-temporal origin and captured one ~45-s seizure. The patient underwent a right temporal resection from the anterior temporal neocortex and amygdala to the mid-posterior temporal neocortex, sparing the hippocampus proper. She remains seizure-free 21 months postoperatively. The histopathological assessment confirmed frank focal cortical dysplasia (FCD) type IIa in the MEG-defined SOZ, which was based on source imaging of averaged ictal spikes at seizure onset. We investigated temporal changes (inter-ictal, pre-ictal, and ictal periods) together with spatial differences (SOZ vs. control regions) in spectral parameters of background brain activity, namely the aperiodic broadband offset and slope, and assessed how they confounded the interpretation of apparent variations of signal power in typical electrophysiological bands. Our data show that the SOZ was associated with a higher aperiodic offset and exponent during the seizure compared to control regions. Both parameters increased in all regions from 2 min before the seizure onwards. Regions anatomically closer to the SOZ also expressed higher values compared to contralateral regions, potentially indicating ictal spread. We also show that narrow-band power changes were caused by these fluctuations in the aperiodic component of ongoing brain activity. Our results indicate that the broadband aperiodic component of ongoing brain activity cannot be reduced to background noise of no physiological interest, and rather may be indicative of the neuropathophysiology of the SOZ. We believe these findings will inspire future studies of ictal MEG cases and confirm their significance.
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Affiliation(s)
- Saskia van Heumen
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Jeremy T. Moreau
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
- Department of Pediatric Surgery, Division of Neurosurgery, Montreal Children’s Hospital, Montreal, QC, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Elisabeth Simard-Tremblay
- Department of Pediatrics, Division of Pediatric Neurology, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada
| | - Steffen Albrecht
- Department of Pathology, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada
| | - Roy WR. Dudley
- Department of Pediatric Surgery, Division of Neurosurgery, Montreal Children’s Hospital, Montreal, QC, Canada
| | - Sylvain Baillet
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
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Etiologic classification of infantile spasms using positron emission/magnetic resonance imaging and the efficacy of adrenocorticotropic hormone therapy. Eur J Nucl Med Mol Imaging 2020; 47:1585-1595. [PMID: 31901104 DOI: 10.1007/s00259-019-04665-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to investigate if the etiologic classification of infantile spasm (IS) using positron emission tomography/magnetic resonance imaging (PET/MR) is feasible. Based on the classified etiologic groups, we further evaluated the efficacy of adrenocorticotropic hormone (ACTH) therapy in different IS groups. MATERIALS AND METHODS One hundred fifty-five children diagnosed with IS were included in this study. A qualitative assessment of the PET/MR images was performed. The abnormal lesions localized with both MR and PET images were considered to be epileptic foci, and the patients with these lesions were classified into the structural-metabolic group. For the remaining patients, quantitative analyses were further performed on whole-brain T1-weighted (T1WI) and PET images, based on the asymmetry index of bilateral volumes and metabolic quantifications. Patients with asymmetry indices above a certain threshold (15%) were classified into the structural-metabolic group. The patients without positive finding from either qualitative or quantitative analyses were assigned to the unknown etiology group. The efficacy of ACTH therapy was evaluated in the different IS groups. RESULTS Among the 155 children with IS, 18 genetic cases were first diagnosed by the genetic testing. In the remaining 137 cases, 49 cases were identified with structural-metabolic etiology using qualitative PET/MR assessments. Fifty-two cases were newly diagnosed with quantitative analysis. The remaining 36 cases were classified into the unknown etiology group. The efficacy of ACTH therapy was statistically different for the different etiology groups (p < 0.001). The respective efficacy rates for the genetic, qualitative structural-metabolic, quantitative structural-metabolic, and unknown etiology groups were 27.8% (5/18), 30.61% (15/49), 34.62% (18/52), and 72.22% (26/36), respectively. CONCLUSIONS The combination of PET and MR provides additional diagnostic information for IS. Quantitative analysis can further improve patient etiologic classifications and the predication of therapy efficacies.
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Abstract
Purpose of review Functional neuroimaging with PET and SPECT is a commonly used tool in presurgical evaluation. The following article reviews the literature of PET and SPECT in presurgical assessment of epilepsies published in the last year. Recent findings FDG-PET adds concomitant information in temporal and extratemporal lobe epilepsy in adults and children. The pattern of hypometabolism in FDG-PET is a good additional predictor or seizure outcome in TLE with mesial temporal sclerosis or negative MRI. There is growing evidence that diagnostic value of FDG-PET increases with postprocessing. Although several methods were applied in the reviewed literature, all of them seem to outperform the visual analysis. Imaging of the epileptic focus with ictal SPECT is depending on short injection latencies. It is particularly useful in patients with nonlesional MRI and mostly of extratemporal localization. Areas of hyperperfusion remote of SOZ are reflecting the epileptic network. Combining more concordant investigations including PET and SPECT in MRI-negative evaluation adds to better presurgical stratification and therefore, better postsurgical outcome. FET-PET shows increased uptake in status epilepticus. Summary PET and SPECT are important investigations to localize the epileptic focus in temporal lobe and nonlesional extratemporal epilepsies. Postprocessing for both modalities is important to increase diagnostic value.
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Minardi C, Minacapelli R, Valastro P, Vasile F, Pitino S, Pavone P, Astuto M, Murabito P. Epilepsy in Children: From Diagnosis to Treatment with Focus on Emergency. J Clin Med 2019; 8:jcm8010039. [PMID: 30609770 PMCID: PMC6352402 DOI: 10.3390/jcm8010039] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/09/2018] [Accepted: 12/26/2018] [Indexed: 12/13/2022] Open
Abstract
Seizures are defined as a transient occurrence of signs and symptoms due to the abnormal, excessive, or synchronous neuronal activity in the brain characterized by abrupt and involuntary skeletal muscle activity. An early diagnosis, treatment, and specific medical support must be performed to prevent Status Epilepticus (SE). Seizure onset, especially in the child population, is related to specific risk factors like positive family history, fever, infections, neurological comorbidity, premature birth, mother’s alcohol abuse, and smoking in pregnancy. Early death risk in children without neurological comorbidity is similar to the general population. Diagnosis is generally based on the identification of continuous or recurrent seizures but Electroencephalogram (EEG) evaluation could be useful if SE condition is suspected. The main goal of therapy is to counteract the pathological mechanism which occurs in SE before neural cells are irreversibly damaged. According to the latest International Guidelines and Recommendations of seizure related diseases, a schematic and multi-stage pharmacological and diagnostic approach is proposed especially in the management of SE and its related causes in children. First measures should focus on early and appropriate drugs administration at adequate dosage, airway management, monitoring vital signs, Pediatric Intensive Care Unit (PICU) admission, and management of parent anxiety.
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Affiliation(s)
- Carmelo Minardi
- Department of Anesthesiology, AOU Policlinico-Vittorio Emanuele, University of Catania Via S. Sofia, 78, 95123 Catania, Italy.
| | - Roberta Minacapelli
- Department of Anesthesiology, AOU Policlinico-Vittorio Emanuele, University of Catania Via S. Sofia, 78, 95123 Catania, Italy.
| | - Pietro Valastro
- Department of Anesthesiology, AOU Policlinico-Vittorio Emanuele, University of Catania Via S. Sofia, 78, 95123 Catania, Italy.
| | - Francesco Vasile
- Department of Anesthesiology, AOU Policlinico-Vittorio Emanuele, University of Catania Via S. Sofia, 78, 95123 Catania, Italy.
| | - Sofia Pitino
- Department of Anesthesiology, AOU Policlinico-Vittorio Emanuele, University of Catania Via S. Sofia, 78, 95123 Catania, Italy.
| | - Piero Pavone
- Department of Pediatrics, AOU Policlinico-Vittorio Emanuele, University of Catania Via S. Sofia, 78, 95123 Catania, Italy.
| | - Marinella Astuto
- Department of Anesthesiology, AOU Policlinico-Vittorio Emanuele, University of Catania Via S. Sofia, 78, 95123 Catania, Italy.
| | - Paolo Murabito
- Department of Anesthesiology, AOU Policlinico-Vittorio Emanuele, University of Catania Via S. Sofia, 78, 95123 Catania, Italy.
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Perissinotti A, Niñerola-Baizán A, Rubí S, Carreño M, Marti-Fuster B, Aparicio J, Mayoral M, Donaire A, Sanchez-Izquierdo N, Bargalló N, Rumiá J, Boget T, Pons F, Lomeña F, Ros D, Pavía J, Setoain X. PISCOM: a new procedure for epilepsy combining ictal SPECT and interictal PET. Eur J Nucl Med Mol Imaging 2018; 45:2358-2367. [PMID: 30069576 PMCID: PMC6208811 DOI: 10.1007/s00259-018-4080-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE We present a modified version of the SISCOM procedure that uses interictal PET instead of interictal SPECT for seizure onset zone localization. We called this new nuclear imaging processing technique PISCOM (PET interictal subtracted ictal SPECT coregistered with MRI). METHODS We retrospectively studied 23 patients (age range 4-61 years) with medically refractory epilepsy who had undergone MRI, ictal SPECT, interictal SPECT and interictal FDG PET and who had been seizure-free for at least 2 years after surgical treatment. FDG PET images were reprocessed (rFDG PET) to assimilate SPECT features for image subtraction. Interictal SPECT and rFDG PET were compared using statistical parametric mapping (SPM). PISCOM and SISCOM images were evaluated visually and using an automated volume of interest-based analysis. The results of the two studies were compared with each other and with the known surgical resection site. RESULTS SPM showed no significant differences in cortical activity between SPECT and rFDG PET images. PISCOM and SISCOM showed equivalent results in 17 of 23 patients (74%). The seizure onset zone was successfully identified in 19 patients (83%) by PISCOM and in 17 (74%) by SISCOM: in 15 patients (65%) the two techniques showed concordant successful results. The volume of interest-based analysis showed no significant differences between PISCOM and SISCOM in identifying the extension of the seizure onset zone. However, PISCOM showed a lower amount of indeterminate activity due to propagation, background or artefacts. CONCLUSION Preliminary findings of this initial proof-of-concept study suggest that perfusion and glucose metabolism in the cerebral cortex can be correlated and that PISCOM may be a valid technique for identification of the seizure onset zone. However, further studies are needed to validate these results.
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Affiliation(s)
- Andrés Perissinotti
- Department of Nuclear Medicine, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
| | - Aida Niñerola-Baizán
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Sebastià Rubí
- Nuclear Medicine Department, Hospital Universitari Son Espases, Palma, Spain.,Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Spain
| | - Mar Carreño
- Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Berta Marti-Fuster
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Javier Aparicio
- Department of Neurology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Maria Mayoral
- Department of Nuclear Medicine, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
| | | | | | - Nuria Bargalló
- Department of Radiology, Hospital Clínic, Barcelona, Spain
| | - Jordi Rumiá
- Department of Neurosurgery, Hospital Clínic, Barcelona, Spain
| | - Teresa Boget
- Department of Psychiatry and Psychology, Hospital Clínic, Barcelona, Spain
| | - Francesca Pons
- Department of Nuclear Medicine, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Francisco Lomeña
- Department of Nuclear Medicine, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
| | - Domènec Ros
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Javier Pavía
- Department of Nuclear Medicine, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
| | - Xavier Setoain
- Department of Nuclear Medicine, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain. .,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain. .,University of Barcelona, Barcelona, Spain.
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Xiang J, Wen F, Zhang L, Zhou Y. FOXD3 inhibits SCN2A gene transcription in intractable epilepsy cell models. Exp Neurol 2017; 302:14-21. [PMID: 29288635 DOI: 10.1016/j.expneurol.2017.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 12/20/2017] [Accepted: 12/26/2017] [Indexed: 12/28/2022]
Abstract
The expression of sodium voltage-gated channel alpha subunit 2 (SCN2A) is closely related to the development of epilepsy. This study investigated regulatory element of the SCN2A gene involved in epilepsy. An intractable epilepsy cell model was constructed using hippocampal primary neurons and the SH-SY5Y cell line. SCN2A protein and gene expression in cells as well as the level of lactic acid dehydrogenase (LDH) in the cell culture supernatants was detected. Potential regulatory factors of SCN2A and its upstream regulatory elements were identified using the dual-luciferase reporter assay. Finally, the role of the hypothetical transcription factor in epilepsy was examined by using its small interfering RNA (siRNA). Results found that levels of LDH and expression of the hypothetical transcription factor, Forkhead box D3 (FOXD3), was both increased in the model cells, whereas that of SCN2A was decreased. The results of dual-luciferase reporter assays revealed that an upstream region of SCN2A gene spanning from nucleotides -1617 to -1470 was a transcription factor binding region and a trans-acting factor role of FOXD3 was identified in the core region (GGCAAAATTAT). Then the FOXD3 binding site was further verified by the chromatin immunoprecipitation (ChIP) assay and electrophoretic mobility shift assay (EMSA). After SH-SY5Y cells were transfected with FOXD3 siRNA, the release of LDH into culture supernatants and the LDH expression levels in cells were significantly decreased. SCN2A expression in model cells was increased by knockdown of FOXD3. Therefore, this study demonstrated that FOXD3 is a trans-acting factor of SCN2A, and this mechanism may play a role in cell injury after epilepsy.
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Affiliation(s)
- Jun Xiang
- Department of Neurosurgery, The Second Xiang-Ya Hospital of Central South University, Changsha 410011, Hunan Province, China.
| | - Fang Wen
- Neurology Electroencephalogram Room of Neurology Department, The Second Xiang-Ya Hospital of Central South University, Changsha 410011, Hunan Province, China
| | - Lingyun Zhang
- Department of Neurosurgery, The Second Xiang-Ya Hospital of Central South University, Changsha 410011, Hunan Province, China
| | - Yu Zhou
- Department of Neurosurgery, The Second Xiang-Ya Hospital of Central South University, Changsha 410011, Hunan Province, China
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Zucchetta P. Letter From the Guest Editor. Semin Nucl Med 2017; 47:100-101. [PMID: 28236997 DOI: 10.1053/j.semnuclmed.2016.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine DIMED University-Hospital of Padova, Italy.
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