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van Dalen T, Kirkham JF, Chari A, D'Arco F, Moeller F, Eltze C, Cross JH, Tisdall MM, Thornton RC. Characterizing Frontal Lobe Seizure Semiology in Children. Ann Neurol 2024; 95:1138-1148. [PMID: 38624073 DOI: 10.1002/ana.26922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE The objective was to analyze seizure semiology in pediatric frontal lobe epilepsy patients, considering age, to localize the seizure onset zone for surgical resection in focal epilepsy. METHODS Fifty patients were identified retrospectively, who achieved seizure freedom after frontal lobe resective surgery at Great Ormond Street Hospital. Video-electroencephalography recordings of preoperative ictal seizure semiology were analyzed, stratifying the data based on resection region (mesial or lateral frontal lobe) and age at surgery (≤4 vs >4). RESULTS Pediatric frontal lobe epilepsy is characterized by frequent, short, complex seizures, similar to adult cohorts. Children with mesial onset had higher occurrence of head deviation (either direction: 55.6% vs 17.4%; p = 0.02) and contralateral head deviation (22.2% vs 0.0%; p = 0.03), ictal body-turning (55.6% vs 13.0%; p = 0.006; ipsilateral: 55.6% vs 4.3%; p = 0.0003), and complex motor signs (88.9% vs 56.5%; p = 0.037). Both age groups (≤4 and >4 years) showed hyperkinetic features (21.1% vs 32.1%), contrary to previous reports. The very young group showed more myoclonic (36.8% vs 3.6%; p = 0.005) and hypomotor features (31.6% vs 0.0%; p = 0.003), and fewer behavioral features (36.8% vs 71.4%; p = 0.03) and reduced responsiveness (31.6% vs 78.6%; p = 0.002). INTERPRETATION This study presents the most extensive semiological analysis of children with confirmed frontal lobe epilepsy. It identifies semiological features that aid in differentiating between mesial and lateral onset. Despite age-dependent differences, typical frontal lobe features, including hyperkinetic seizures, are observed even in very young children. A better understanding of pediatric seizure semiology may enhance the accuracy of onset identification, and enable earlier presurgical evaluation, improving postsurgical outcomes. ANN NEUROL 2024;95:1138-1148.
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Affiliation(s)
- Thijs van Dalen
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Jessica F Kirkham
- Department of Pediatric Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Aswin Chari
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Felice D'Arco
- Department of Pediatric Neuroradiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Friederike Moeller
- Department of Pediatric Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
- University College London Great Ormond Street Institute for Child Health, London, UK
| | - Christin Eltze
- Department of Neurology, Great Ormond Street Hospital for Children NHS Trust, London, UK
- University College London Great Ormond Street Institute for Child Health, London, UK
| | - J Helen Cross
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
- University College London Great Ormond Street Institute for Child Health, London, UK
| | - Martin M Tisdall
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Rachel C Thornton
- Department of Pediatric Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
- Department of Neurophysiology, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK
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Lee D, Lee J, Lee J. Frontal Lobe Epilepsy in a Pediatric Population: Characterization of Clinical Manifestations and Semiology. ANNALS OF CHILD NEUROLOGY 2022. [DOI: 10.26815/acn.2022.00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Purpose: Frontal lobe epilepsy (FLE) has various clinical presentations depending on the anatomy involved. Seizures are brief and can mimic psychiatric conditions, and patients often cannot describe the aura. Therefore, it is difficult to characterize the semiology, especially in pediatric patients. This study investigated the characteristics of pediatric FLE.Methods: We retrospectively reviewed the data of pediatric patients with FLE who underwent long-term video-electroencephalography (EEG) monitoring between January 2010 and June 2020. Patients’ demographic data, seizure-related clinical presentations, semiology, brain magnetic resonance imaging (MRI), and EEG data were analyzed.Results: Fifty-six patients were included (31 males, 25 females). The age of seizure onset varied from 1 month to 14 years (mean±standard deviation, 6.1±4.4 years). Seizures were classified into nine categories, including focal tonic (30/56), aura (22/56), hypermotor (17/56), focal clonic (15/56), versive (13/56), and bilateral asymmetric tonic (4/56). Seventeen patients (30.4%) had abnormal MRI results, including focal cortical dysplasia, heterotopic gray matter, and neuroepithelial tumors. Ictal EEG changes were commonly observed in the dorsolateral premotor and central cortices. In focal tonic seizures, EEG changes often originated in the premotor cortex. The location of the lesions on MRI and EEG coincided in six cases.Conclusion: In pediatric FLE, various seizure types occur depending on the ictal anatomic origin, and individual patients had multiple semiologies. Brain MRI was normal in two-thirds of patients, and interictal EEG did not reveal epileptiform discharges in approximately 25%. Semiology reported on the basis of home videos and interictal EEG will help localize the ictal onset zone.
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Kosugi K, Iijima K, Yokosako S, Takayama Y, Kimura Y, Kaneko Y, Sumitomo N, Saito T, Nakagawa E, Sato N, Iwasaki M. Low EEG Gamma Entropy and Glucose Hypometabolism After Corpus Callosotomy Predicts Seizure Outcome After Subsequent Surgery. Front Neurol 2022; 13:831126. [PMID: 35401399 PMCID: PMC8989433 DOI: 10.3389/fneur.2022.831126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients with generalized epilepsy who had lateralized EEG abnormalities after corpus callosotomy (CC) occasionally undergo subsequent surgeries to control intractable epilepsy.ObjectivesThis study evaluated retrospectively the combination of EEG multiscale entropy (MSE) and FDG-PET for identifying lateralization of the epileptogenic zone after CC.MethodsThis study included 14 patients with pharmacoresistant epilepsy who underwent curative epilepsy surgery after CC. Interictal scalp EEG and FDG-PET obtained after CC were investigated to determine (1) whether the MSE calculated from the EEG and FDG-PET findings was lateralized to the surgical side, and (2) whether the lateralization was associated with seizure outcomes.ResultsSeizure reduction rate was higher in patients with lateralized findings to the surgical side than those without (MSE: p < 0.05, FDG-PET: p < 0.05, both: p < 0.01). Seizure free rate was higher in patients with lateralized findings in both MSE and FDG-PET than in those without (p < 0.05).ConclusionsThis study demonstrated that patients with lateralization of MSE and FDG-PET to the surgical side had better seizure outcomes. The combination of MSE and conventional FDG-PET may help to select surgical candidates for additional surgery after CC with good postoperative seizure outcomes.
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Affiliation(s)
- Kenzo Kosugi
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Keiya Iijima
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Suguru Yokosako
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yutaro Takayama
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yuiko Kimura
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yuu Kaneko
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Noriko Sumitomo
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Takashi Saito
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Eiji Nakagawa
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Noriko Sato
- Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
- *Correspondence: Masaki Iwasaki
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Khalaf A, Nadel H, Dahmoush H. Simultaneously Acquired MRI Arterial Spin-Labeling and Interictal FDG-PET Improves Diagnosis of Pediatric Temporal Lobe Epilepsy. AJNR Am J Neuroradiol 2022; 43:468-473. [PMID: 35210273 PMCID: PMC8910808 DOI: 10.3174/ajnr.a7421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 12/06/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Interictal FDG-PET scans are a routine diagnostic technique for the identification of epileptogenic foci in the presurgical work-up of medically refractory pediatric epilepsy. With the advent of PET/MR imaging, it has become possible to simultaneously acquire FDG-PET and arterial spin-labeling perfusion data. The objective of this study was to evaluate whether the incorporation of arterial spin-labeling data with interictal FDG-PET could improve the diagnostic performance metrics of FDG-PET for identification of epileptogenic foci. MATERIALS AND METHODS Forty-five pediatric patients with a mean age of 10.8 years were retrospectively included in this study. These patients all underwent PET/MR imaging to diagnose suspected focal epilepsy. RESULTS When compared to interpretations of interictal FDG findings alone, FDG combined with arterial spin-labeling findings resulted in significantly decreased sensitivity (0.64 versus 0.52, P = .02), significantly increased specificity (0.50 versus 0.75, P = .04), and an increased positive predictive value (0.59 versus 0.75). The decreased sensitivity was found to be primarily driven by patients with extratemporal lobe epilepsy, as a subgroup analysis showed decreased sensitivity for patients with extratemporal epilepsy (0.52 versus 0.38, P = .04), but not for temporal epilepsy (0.83 versus 0.75, P = .16). Additionally, substantial agreement between focal FDG hypometabolism and arterial spin-labeling hypoperfusion was demonstrated with the Cohen κ (0.70, P < .01). CONCLUSIONS These findings suggest that simultaneously acquired interictal FDG-PET and arterial spin-labeling data can improve the diagnosis of epileptogenic foci, especially in the setting of temporal lobe epilepsy where they improve specificity and positive predictive value, with preservation of sensitivity.
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Affiliation(s)
- A.M. Khalaf
- From the Stanford University School of Medicine, Department of Radiology, Division of Nuclear Medicine & Molecular Imaging, Division of Pediatric Radiology, Division of Neuroimaging & Neurointervention, Stanford University, Stanford, California
| | - H.R. Nadel
- From the Stanford University School of Medicine, Department of Radiology, Division of Nuclear Medicine & Molecular Imaging, Division of Pediatric Radiology, Division of Neuroimaging & Neurointervention, Stanford University, Stanford, California
| | - H.M. Dahmoush
- From the Stanford University School of Medicine, Department of Radiology, Division of Nuclear Medicine & Molecular Imaging, Division of Pediatric Radiology, Division of Neuroimaging & Neurointervention, Stanford University, Stanford, California
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5
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Presurgical evaluation of drug-resistant paediatric focal epilepsy with PISCOM compared to SISCOM and FDG-PET. Seizure 2022; 97:43-49. [DOI: 10.1016/j.seizure.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/26/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
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Kumar A, Shandal V, Juhász C, Chugani HT. PET imaging in epilepsy. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00049-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Habibabadi JM, Doroudinia A, Koma AY, Fesharaki SSH, Aarabi S. Comparison of non-invasive imaging modalities in presurgical evaluation of temporal lobe epilepsy patients: a multicenter study. Acta Neurol Belg 2021; 121:1815-1821. [PMID: 33230739 DOI: 10.1007/s13760-020-01550-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/08/2020] [Indexed: 11/28/2022]
Abstract
Intractable drug-resistant magnetic resonance imaging (MRI) negative epilepsy in one of the complicated issues in neurology. Epilepsy surgery is beneficial treatment of intractable seizures, but precise localization of epileptogenic zone is a major concern. Thirty-four MRI negative drug-resistant epilepsy patients underwent video electroencephalography (EEG), positron emission tomography (PET) scan, and voxel-based morphometry (VBM) MRI from 2014 to 2019. Then, the findings of PET scan and VBM were compared with semiology and long-term electrophysiology. Cohen's kappa-coefficient (k) test was utilized to measure the agreement between our modalities. Among 34 patients with age ranging from 8 to 49 (mean: 29.00 ± standard deviation: 10.35), 19 were male (55.9%) and 15 were female (44.1%). Twenty-one patients (61.76%) had right temporal, 12 patients (35.3%) had left and one patient had bilateral temporal ictal focus according to video EEG. Inter-rater agreement analysis showed that the kappa index between video EEG and PET scan was of almost acceptable (more than 0.4) and there was poor agreement between video EEG and VBM (kappa index = 0.099). PET is highly concordant with video EEG in temporal lobe epilepsy (TLE) and has a considerable agreement in localizing epileptogenic zone while VBM is less.
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Affiliation(s)
| | - Abtin Doroudinia
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Yousefi Koma
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sobhan Aarabi
- Comprehensive Epilepsy Program, Epilepsy Monitoring Unit, Pars Hospital, Tehran, Iran.
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Abstract
BACKGROUND A large number of patients have epilepsy that is intractable and adversely affects a child's lifelong experience with addition societal burden that is disabling and expensive. The last two decades have seen a major explosion of new antiseizure medication options. Despite these advances, children with epilepsy continue to have intractable seizures. An option that has been long available but little used is epilepsy surgery to control intractable epilepsy. METHODS This article is a review of the literature as well as published opinions. RESULTS Epilepsy surgery in pediatrics is an underused modality to effectively treat children with epilepsy. Adverse effects of medication should be weighed against risks of surgery as well as risks of nonefficacy. CONCLUSIONS We discuss an approach to selecting the appropriate pediatric patient for consideration, a detailed evaluation including necessary evaluation, and the creation of an algorithm to approach patients with both generalized and focal epilepsy. We then discuss surgical options available including outcome data. New modalities are also addressed including high-frequency ultrasound and co-registration techniques including magnetic resonance imaging-guided laser therapy.
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Whiting AC, Morita-Sherman M, Li M, Vegh D, Machado de Campos B, Cendes F, Wang X, Bingaman W, Jehi LE. Automated analysis of cortical volume loss predicts seizure outcomes after frontal lobectomy. Epilepsia 2021; 62:1074-1084. [PMID: 33756031 DOI: 10.1111/epi.16877] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Patients undergoing frontal lobectomy demonstrate lower seizure-freedom rates than patients undergoing temporal lobectomy and several other resective interventions. We attempted to utilize automated preoperative quantitative analysis of focal and global cortical volume loss to develop predictive volumetric indicators of seizure outcome after frontal lobectomy. METHODS Ninety patients who underwent frontal lobectomy were stratified based on seizure freedom at a mean follow-up time of 3.5 (standard deviation [SD] 2.5) years. Automated quantitative analysis of cortical volume loss organized by distinct brain region and laterality was performed on preoperative T1-weighted magnetic resonance imaging (MRI) studies. Univariate statistical analysis was used to select potential predictors of seizure freedom. Backward variable selection and multivariate logistical regression were used to develop models to predict seizure freedom. RESULTS Forty-eight of 90 (53.3%) patients were seizure-free at the last follow-up. Several frontal and extrafrontal brain regions demonstrated statistically significant differences in both volumetric cortical volume loss and volumetric asymmetry between the left and right sides in the seizure-free and non-seizure-free cohorts. A final multivariate logistic model utilizing only preoperative quantitative MRI data to predict seizure outcome was developed with a c-statistic of 0.846. Using both preoperative quantitative MRI data and previously validated clinical predictors of seizure outcomes, we developed a model with a c-statistic of 0.897. SIGNIFICANCE This study demonstrates that preoperative cortical volume loss in both frontal and extrafrontal regions can be predictive of seizure outcome after frontal lobectomy, and models can be developed with excellent predictive capabilities using preoperative MRI data. Automated quantitative MRI analysis can be quickly and reliably performed in patients with frontal lobe epilepsy, and further studies may be developed for integration into preoperative risk stratification.
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Affiliation(s)
- Alexander C Whiting
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Manshi Li
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Deborah Vegh
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Fernando Cendes
- Department of Neurology, University of Campinas UNICAMP, Campinas, Brazil
| | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - William Bingaman
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lara E Jehi
- Cleveland Clinic Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
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Abstract
OBJECTIVE. The purpose of this article is to summarize the role of molecular imaging of the brain by use of SPECT, FDG PET, and non-FDG PET radiotracers in epilepsy. CONCLUSION. Quantitative image analysis with PET and SPECT has increased the diagnostic utility of these modalities in localizing epileptogenic onset zones. A multi-modal platform approach integrating the functional imaging of PET and SPECT with the morphologic information from MRI in presurgical evaluation of epilepsy can greatly improve outcomes.
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Rahatli FK, Sezer T, Has AC, Agildere AM. Evaluation of cortical thickness and brain volume on 3 Tesla magnetic resonance imaging in children with frontal lobe epilepsy. Neurol Sci 2019; 41:825-833. [DOI: 10.1007/s10072-019-04135-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/31/2019] [Indexed: 11/30/2022]
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12
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Juhász C, John F. Utility of MRI, PET, and ictal SPECT in presurgical evaluation of non-lesional pediatric epilepsy. Seizure 2019; 77:15-28. [PMID: 31122814 DOI: 10.1016/j.seizure.2019.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 02/12/2019] [Accepted: 05/10/2019] [Indexed: 12/12/2022] Open
Abstract
Children with epilepsy and normal structural MRI pose a particular challenge in localization of epileptic foci for surgical resection. Many of these patients have subtle structural lesions such as mild cortical dysplasia that can be missed by conventional MRI but may become detectable by optimized and advanced MRI acquisitions and post-processing. Specificity of objective analytic techniques such as voxel-based morphometry remains an issue. Combination of MRI with functional imaging approaches can improve the accuracy of detecting epileptogenic brain regions. Analysis of glucose positron emission tomography (PET) combined with high-resolution MRI can optimize detection of hypometabolic cortex associated with subtle cortical malformations and can also enhance presurgical evaluation in children with epileptic spasms. Additional PET tracers may detect subtle epileptogenic lesions and cortex with enhanced specificity in carefully selected subgroups with various etiologies; e.g., increased tryptophan uptake can identify epileptogenic cortical dysplasia in the interictal state. Subtraction ictal SPECT can be also useful to delineate ictal foci in those with non-localizing PET or after failed surgical resection. Presurgical delineation of language and motor cortex and the corresponding white matter tracts is increasingly reliable by functional MRI and DTI techniques; with careful preparation, these can be useful even in young and sedated children. While evidence-based pediatric guidelines are still lacking, the data accumulated in the last decade strongly indicate that multimodal imaging with combined analysis of MRI, PET, and/or ictal SPECT data can optimize the detection of subtle epileptogenic lesions and facilitate seizure-free outcome while minimizing the postsurgical functional deficit in children with normal conventional MRI.
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Affiliation(s)
- Csaba Juhász
- Department of Pediatrics, Wayne State University, PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, Michigan, 48201, USA; Departments of Neurology and Neurosurgery, Wayne State University, 4201 St. Antoine St., Detroit, Michigan, 48201, USA.
| | - Flóra John
- Department of Pediatrics, Wayne State University, PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, 3901 Beaubien St., Detroit, Michigan, 48201, USA; Department of Neurology, University of Pécs, H-7623, Rét u. 2., Pécs, Hungary.
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13
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Pilli VK, Jeong JW, Konka P, Kumar A, Chugani HT, Juhász C. Objective PET study of glucose metabolism asymmetries in children with epilepsy: Implications for normal brain development. Hum Brain Mapp 2018; 40:53-64. [PMID: 30136325 DOI: 10.1002/hbm.24354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/09/2018] [Accepted: 08/03/2018] [Indexed: 11/09/2022] Open
Abstract
Clinical interpretation of cerebral positron emission tomography with 2-deoxy-2[F-18]fluoro-d-glucose (FDG-PET) images often relies on evaluation of regional asymmetries. This study was designed to establish age-related variations in regional cortical glucose metabolism asymmetries in the developing human brain. FDG-PET scans of 58 children (age: 1-18 years) were selected from a large single-center pediatric PET database. All children had a history of epilepsy, normal MRI, and normal pattern of glucose metabolism on visual evaluation. PET images were analyzed objectively by statistical parametric mapping with the use of age-specific FDG-PET templates. Regional FDG uptake was measured in 35 cortical regions in both hemispheres using an automated anatomical labeling atlas, and left/right ratios were correlated with age, gender, and epilepsy variables. Cortical glucose metabolism was mostly symmetric in young children and became increasingly asymmetric in older subjects. Specifically, several frontal cortical regions showed an age-related increase of left > right asymmetries (mean: up to 10%), while right > left asymmetries emerged in posterior cortex (including portions of the occipital, parietal, and temporal lobe) in older children (up to 9%). Similar trends were seen in a subgroup of 39 children with known right-handedness. Age-related correlations of regional metabolic asymmetries showed no robust gender differences and were not affected by epilepsy variables. These data demonstrate a region-specific emergence of cortical metabolic asymmetries between age 1-18 years, with left > right asymmetry in frontal and right > left asymmetry in posterior regions. The findings can facilitate correct interpretation of cortical regional asymmetries on pediatric FDG-PET images across a wide age range.
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Affiliation(s)
- Vinod K Pilli
- The Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, Michigan.,PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan
| | - Jeong-Won Jeong
- The Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, Michigan.,Department of Neurology, Wayne State University, Detroit, Michigan.,PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan
| | - Praneetha Konka
- The Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, Michigan.,PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan
| | - Ajay Kumar
- The Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, Michigan.,Department of Neurology, Wayne State University, Detroit, Michigan.,PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan
| | - Harry T Chugani
- The Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, Michigan.,Department of Neurology, Wayne State University, Detroit, Michigan.,PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan
| | - Csaba Juhász
- The Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, Michigan.,Department of Neurology, Wayne State University, Detroit, Michigan.,PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, Michigan
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Wu Q, Zhao CW, Long Z, Xiao B, Feng L. Anatomy Based Networks and Topology Alteration in Seizure-Related Cognitive Outcomes. Front Neuroanat 2018; 12:25. [PMID: 29681801 PMCID: PMC5898178 DOI: 10.3389/fnana.2018.00025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 03/20/2018] [Indexed: 01/19/2023] Open
Abstract
Epilepsy is a paroxysmal neurological disorder characterized by recurrent and unprovoked seizures affecting approximately 50 million people worldwide. Cognitive dysfunction induced by seizures is a severe comorbidity of epilepsy and epilepsy syndromes and reduces patients’ quality of life. Seizures, along with accompanying histopathological and pathophysiological changes, are associated with cognitive comorbidities. Advances in imaging technology and computing allow anatomical and topological changes in neural networks to be visualized. Anatomical components including the hippocampus, amygdala, cortex, corpus callosum (CC), cerebellum and white matter (WM) are the fundamental components of seizure- and cognition-related topological networks. Damage to these structures and their substructures results in worsening of epilepsy symptoms and cognitive dysfunction. In this review article, we survey structural, network changes and topological alteration in different regions of the brain and in different epilepsy and epileptic syndromes, and discuss what these changes may mean for cognitive outcomes related to these disease states.
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Affiliation(s)
- Qian Wu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Charlie W Zhao
- Department of Neuroscience, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Zhe Long
- Sydney Medical School and the Brain & Mind Institute, The University of Sydney, Camperdown, NSW, Australia
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
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15
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Verger A, Lagarde S, Maillard L, Bartolomei F, Guedj E. Brain molecular imaging in pharmacoresistant focal epilepsy: Current practice and perspectives. Rev Neurol (Paris) 2018; 174:16-27. [DOI: 10.1016/j.neurol.2017.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
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16
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Vidaurre J, Twanow JDE. Attention Deficit Hyperactivity Disorder and Associated Cognitive Dysfunction in Pediatric Epilepsy. Semin Pediatr Neurol 2017; 24:282-291. [PMID: 29249508 DOI: 10.1016/j.spen.2017.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is the most common neuropsychiatric comorbidity associated with childhood epilepsy, affecting about a third of children with epilepsy. In contrast, ADHD in the general population occurs in 4%-12% of school-aged children. The cause of this association remains unclear. It is likely that common mechanisms underlie the vulnerability for both executive deficits and epileptogenesis. There are characteristics unique to children with ADHD and epilepsy. The inattentive type of ADHD is more prevalent than the combined presentation in children with epilepsy, while the combined type is more common in the general population. Interestingly, there is an equal sex distribution of ADHD in patients with epilepsy, while in the general population, ADHD is 3-7 times more prevalent in boys. Specific features of ADHD seen in different epilepsy syndromes are frequently associated with executive deficits. Early screening of ADHD symptoms in children with epilepsy is essential, as timely interventions can improve academic and social function and outcomes. The mainstays of therapy include behavioral interventions and pharmacotherapy, with evidence demonstrating that stimulants are both safe and effective in children with ADHD and epilepsy.
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Affiliation(s)
- Jorge Vidaurre
- From the Pediatric Neurology-Epilepsy Division, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
| | - Jaime Dawn E Twanow
- From the Pediatric Neurology-Epilepsy Division, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
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17
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Ergün EL, Saygi S, Yalnizoglu D, Oguz KK, Erbas B. SPECT-PET in Epilepsy and Clinical Approach in Evaluation. Semin Nucl Med 2017; 46:294-307. [PMID: 27237440 DOI: 10.1053/j.semnuclmed.2016.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In epilepsy, a detailed history, blood chemistry, routine electroencephalography, and brain MRI are important for the diagnosis of seizure type or epilepsy syndrome for the decision of appropriate drug treatment. Although antiepileptic drugs are mostly successful for controlling epileptic seizures, 20%-30% patients are resistant to medical treatment and continue to have seizures. In this intractable patient group, surgical resection is the primarily preferred treatment option. This particular group of patients should be referred to the epilepsy center for detailed investigation and further treatment. When the results of electroencephalography, MRI, and clinical status are discordant or there is no structural lesion on MRI, ictal-periictal SPECT, and interictal PET play key roles for lateralization or localization of epileptic region and guidance for the subsequent subdural electrode placement in intractable epilepsy. SPECT and PET show the functional status of the brain. SPECT and PET play important roles in the evaluation of epilepsy sydromes in childhood by showing abnormal brain regions. Most of the experience has been gained with (18)FDG-PET, in this respect. (11)C-flumazenil-PET usually deliniates the seizure focus more smaller than (18)FDG-PET and is sensitive in identifying medial temporal sclerosis. (11)C-alpha-methyl-l-tryptophan is helpful in the differentiation of epileptogenic and nonepileptogenic regions in children especially in tuberous sclerosis and multifocal cortical dysplasia for the evaluation of surgery. Finally, when there is concordance among these detailed investigations, resective surgery or palliative procedures can be discussed individually.
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Affiliation(s)
- Eser Lay Ergün
- Department of Nuclear Medicine, Hacettepe University, Medical School, Ankara, Turkey.
| | - Serap Saygi
- Department of Neurology, Hacettepe University, Medical School, Ankara, Turkey
| | - Dilek Yalnizoglu
- Department of Pediatric Neurology, Hacettepe University, Medical School, Ankara, Turkey
| | - Kader Karli Oguz
- Department of Diagnostic Radiology, Hacettepe University, Medical School, Ankara, Turkey
| | - Belkis Erbas
- Department of Nuclear Medicine, Hacettepe University, Medical School, Ankara, Turkey
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18
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Jeong JW, Asano E, Kumar Pilli V, Nakai Y, Chugani HT, Juhász C. Objective 3D surface evaluation of intracranial electrophysiologic correlates of cerebral glucose metabolic abnormalities in children with focal epilepsy. Hum Brain Mapp 2017; 38:3098-3112. [PMID: 28322026 DOI: 10.1002/hbm.23577] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 03/01/2017] [Accepted: 03/09/2017] [Indexed: 12/27/2022] Open
Abstract
To determine the spatial relationship between 2-deoxy-2[18 F]fluoro-D-glucose (FDG) metabolic and intracranial electrophysiological abnormalities in children undergoing two-stage epilepsy surgery, statistical parametric mapping (SPM) was used to correlate hypo- and hypermetabolic cortical regions with ictal and interictal electrocorticography (ECoG) changes mapped onto the brain surface. Preoperative FDG-PET scans of 37 children with intractable epilepsy (31 with non-localizing MRI) were compared with age-matched pseudo-normal pediatric control PET data. Hypo-/hypermetabolic maps were transformed to 3D-MRI brain surface to compare the locations of metabolic changes with electrode coordinates of the ECoG-defined seizure onset zone (SOZ) and interictal spiking. While hypometabolic clusters showed a good agreement with the SOZ on the lobar level (sensitivity/specificity = 0.74/0.64), detailed surface-distance analysis demonstrated that large portions of ECoG-defined SOZ and interictal spiking area were located at least 3 cm beyond hypometabolic regions with the same statistical threshold (sensitivity/specificity = 0.18-0.25/0.94-0.90 for overlap 3-cm distance); for a lower threshold, sensitivity for SOZ at 3 cm increased to 0.39 with a modest compromise of specificity. Performance of FDG-PET SPM was slightly better in children with smaller as compared with widespread SOZ. The results demonstrate that SPM utilizing age-matched pseudocontrols can reliably detect the lobe of seizure onset. However, the spatial mismatch between metabolic and EEG epileptiform abnormalities indicates that a more complete SOZ detection could be achieved by extending intracranial electrode coverage at least 3 cm beyond the metabolic abnormality. Considering that the extent of feasible electrode coverage is limited, localization information from other modalities is particularly important to optimize grid coverage in cases of large hypometabolic cortex. Hum Brain Mapp 38:3098-3112, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Jeong-Won Jeong
- Departments of Pediatrics and Neurology, School of Medicine, Wayne State University, Detroit, Michigan.,Translational Imaging Laboratory, PET Center, Children's Hospital of Michigan, Detroit, Michigan
| | - Eishi Asano
- Departments of Pediatrics and Neurology, School of Medicine, Wayne State University, Detroit, Michigan
| | - Vinod Kumar Pilli
- Departments of Pediatrics and Neurology, School of Medicine, Wayne State University, Detroit, Michigan.,Translational Imaging Laboratory, PET Center, Children's Hospital of Michigan, Detroit, Michigan
| | - Yasuo Nakai
- Departments of Pediatrics and Neurology, School of Medicine, Wayne State University, Detroit, Michigan
| | - Harry T Chugani
- Department of Neurology, Nemours DuPont Hospital for Children, Wilmington, Delaware.,Thomas Jefferson University School of Medicine, Philadelphia, Pennysylvania
| | - Csaba Juhász
- Departments of Pediatrics and Neurology, School of Medicine, Wayne State University, Detroit, Michigan.,Translational Imaging Laboratory, PET Center, Children's Hospital of Michigan, Detroit, Michigan
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19
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Kumar A, Chugani HT. The Role of Radionuclide Imaging in Epilepsy, Part 1: Sporadic Temporal and Extratemporal Lobe Epilepsy. J Nucl Med Technol 2017; 45:14-21. [PMID: 28258205 DOI: 10.2967/jnumed.112.114397] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 08/06/2013] [Indexed: 11/16/2022] Open
Abstract
Epilepsy is one of the most common yet diverse neurologic disorders, affecting almost 1%-2% of the population. Presently, radionuclide imaging such as PET and SPECT is not used in the primary diagnosis or evaluation of recent-onset epilepsy. However, it can play a unique and important role in certain specific situations, such as in noninvasive presurgical localization of epileptogenic brain regions in intractable-seizure patients being considered for epilepsy surgery. Radionuclide imaging can be particularly useful if MR imaging is either negative for lesions or shows several lesions of which only 1 or 2 are suspected to be epileptogenic and if electroencephalogram changes are equivocal or discordant with the structural imaging. Similarly, PET and SPECT can also be useful for evaluating the functional integrity of the rest of the brain and may provide useful information on the possible pathogenesis of the neurocognitive and behavioral abnormalities frequently observed in these patients.
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Affiliation(s)
- Ajay Kumar
- PET Center, Department of Pediatrics, Neurology, and Radiology, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Harry T Chugani
- PET Center, Department of Pediatrics, Neurology, and Radiology, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
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20
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Compatibility of MRI and FDG-PET findings with histopathological results in patients with focal cortical dysplasia. Seizure 2017; 45:80-86. [DOI: 10.1016/j.seizure.2016.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 11/26/2016] [Accepted: 11/29/2016] [Indexed: 11/18/2022] Open
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21
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Gold JA, Sher Y, Maldonado JR. Frontal Lobe Epilepsy: A Primer for Psychiatrists and a Systematic Review of Psychiatric Manifestations. PSYCHOSOMATICS 2016; 57:445-64. [DOI: 10.1016/j.psym.2016.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
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22
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23
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Fan PC, Peng SSF, Yen RF, Shieh JY, Kuo MF. Neuroimaging and electroencephalographic changes after vagus nerve stimulation in a boy with medically intractable myoclonic astatic epilepsy. J Formos Med Assoc 2014; 113:258-63. [DOI: 10.1016/j.jfma.2013.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 01/30/2013] [Accepted: 02/20/2013] [Indexed: 11/17/2022] Open
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24
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Siclari F, Prior JO, Rossetti AO. Ictal cerebral positron emission tomography (PET) in focal status epilepticus. Epilepsy Res 2013; 105:356-61. [PMID: 23582605 DOI: 10.1016/j.eplepsyres.2013.03.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 02/26/2013] [Accepted: 03/17/2013] [Indexed: 11/30/2022]
Abstract
The diagnosis of focal status epilepticus (SE) can be challenging, particularly when clinical manifestations leave doubts about its nature, and electroencephalography (EEG) is not conclusive. This work addresses the utility of ictal (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) in focal SE, which was performed in eight patients in whom SE was finally diagnosed. Clinical, MRI and EEG data were reviewed. (18)F-FDG-PET proved useful: (1) to establish the diagnosis of focal SE, when clinical elements were equivocal or the EEG did not show clear-cut epileptiform abnormalities; (2) to delineate the epileptogenic area in view of possible resective surgery; and (3) when clinical features, MRI and EEG were incongruent regarding the origin of SE. We suggest that ictal (18)F-FDG-PET may represent a valuable diagnostic tool in selected patients with focal SE or frequent focal seizures.
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Affiliation(s)
- Francesca Siclari
- Department of Neurology, Lausanne University Hospital, Lausanne, Switzerland.
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25
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Juhász C. The impact of positron emission tomography imaging on the clinical management of patients with epilepsy. Expert Rev Neurother 2013; 12:719-32. [PMID: 22650174 DOI: 10.1586/ern.12.48] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Clinical positron emission tomography (PET) imaging of human epilepsy has a 30-year history, but it is still searching for its exact role among rapidly advancing neuroimaging techniques. The vast majority of epilepsy PET studies used this technique to improve detection of epileptic foci for surgical resection. Here, we review the main trends emerging from three decades of PET research in epilepsy, with a particular emphasis on how PET imaging has impacted on the clinical management of patients with intractable epilepsy. While reviewing the latest studies, we also present an argument for a changing role of PET and molecular imaging in the future, with an increasing focus on epileptogenesis and newly discovered molecular mechanisms of epilepsy. These new applications will be facilitated by technological advances, such as the use of integrated PET/MRI systems and utilization of novel radiotracers, which may also enhance phenotype-genotype correlations and assist rational, individualized treatment strategies.
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Affiliation(s)
- Csaba Juhász
- Department of Pediatrics, Wayne State University School of Medicine, PET Center, Children's Hospital of Michigan, Detroit, MI 48201, USA.
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26
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Abstract
Dorsolateral frontal lobe seizures often present as a diagnostic challenge. The diverse semiologies may not produce lateralizing or localizing signs and can appear bizarre and suggest psychogenic events. Unfortunately, scalp electroencephalographic (EEG) and magnetic resonance imaging (MRI) are often unsatisfactory. It is not uncommon that these traditional diagnostic studies are either unhelpful or even misleading. In some cases, SPECT and positron emission tomography imaging can be an effective tool to identify the origin of seizures. However, these techniques and other emerging techniques all have limitations, and new approaches are needed to improve source localization.
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Affiliation(s)
- Ricky W Lee
- Department of Neurology, Division of Clinical Neurophysiology, Mayo Clinic, Rochester, MN, USA
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27
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Widjaja E, Shammas A, Vali R, Otsubo H, Ochi A, Snead OC, Go C, Charron M. FDG-PET and magnetoencephalography in presurgical workup of children with localization-related nonlesional epilepsy. Epilepsia 2013; 54:691-9. [DOI: 10.1111/epi.12114] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2012] [Indexed: 11/28/2022]
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28
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Donaire A, Capdevila A, Carreño M, Setoain X, Rumià J, Aparicio J, Campistol J, Padilla N, Sanmartí F, Vernet O, Pintor L, Boget T, Ortells J, Bargalló N. Identifying the cortical substrates of interictal epileptiform activity in patients with extratemporal epilepsy: An EEG-fMRI sequential analysis and FDG-PET study. Epilepsia 2013; 54:678-90. [PMID: 23362864 DOI: 10.1111/epi.12091] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to apply sequential analysis of electroencephalography-functional magnetic resonance imaging (EEG-fMRI) data to study the cortical substrates related to the generation of the interictal epileptiform activity (IEA) in patients with pharmacoresistant extratemporal epilepsy. METHODS We analyzed fMRI data from 21 children, adolescents, and young adults patients who showed frequent bursts or runs of spikes on EEG, by using the sequential analysis method. We contrasted consecutive fixed-width blocks of 10 s to obtain the relative variations in cerebral activity along the entire fMRI runs. Significant responses (p < 0.05, family-wise error (FWE) corrected), time-related to the IEA recorded on scalp EEG, were considered potential IEA cortical sources. These results were compared with those from the fluorodeoxyglucose-positron emission tomography (FDG-PET), intracranial EEG (two patients), and surgery outcome (eight patients). KEY FINDINGS The typical IEA was recorded in all patients. After the sequential analysis, at least one significant blood oxygen level-dependent (BOLD) response spatially consistent with the presumed epileptogenic zone was found. These IEA-related activation areas coincided when superimposed with the hypometabolism depicted by the FDG-PET. These data were also consistent with the invasive EEG findings. Epileptic seizures were recorded in eight patients. A subset of IEA-associated fMRI activations was consistent the activations at seizure-onset determined by sequential analysis. The inclusion of the IEA-related areas in the resection rendered the patients seizure-free (five of eight operated patients). SIGNIFICANCE The EEG-fMRI data sequential analysis could noninvasively identify cortical areas involved in the IEA generation. The spatial relationship of these areas with the cortical metabolic abnormalities depicted by the FDG-PET and their intrinsic relationship regarding the ictal-onset zone could be useful in epilepsy surgery planning.
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Affiliation(s)
- Antonio Donaire
- Department of Neurology, Hospital Clínic, University of Barcelona, Barcelona, Spain.
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29
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Abstract
Among various neuroimaging techniques used for the evaluation of children with intractable epilepsy, positron emission tomography (PET) employing various PET tracers plays a very important role, especially in localizing areas of focal cortical dysplasia. This is particularly important in infants, where incomplete myelination may limit the structural information provided by MRI. In children with tuberous sclerosis, PET can differentiate between epileptogenic and nonepileptogenic tubers, previously not thought to be possible with neuroimaging. PET may reveal cortical or subcortical abnormalities in various epilepsy syndromes, such as infantile spasms and Landau-Kleffner syndrome. Various other applications of PET have included the investigation of epileptic networks, secondary epileptic foci, dual pathology, and neuroinflammation. Finally, PET can also be used to evaluate various cognitive processes and their underlying neurological substrates and can help in addressing the issue of brain plasticity and reorganization, related to epilepsy.
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Affiliation(s)
- Ajay Kumar
- Departments of Pediatrics and Neurology, School of Medicine, Wayne State University, and PET Center, Children's Hospital of Michigan, Detroit, MI, USA
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30
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Vachhrajani S, de Ribaupierre S, Otsubo H, Ochi A, Weiss SK, Donner EJ, Widjaja E, Kerr E, Smith ML, Drake J, Snead C, Rutka JT. Neurosurgical management of frontal lobe epilepsy in children. J Neurosurg Pediatr 2012; 10:206-16. [PMID: 22838737 DOI: 10.3171/2012.6.peds11125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECT Pediatric frontal lobe epilepsy (FLE) remains a challenging condition for neurosurgeons and epileptologists to manage. Postoperative seizure outcomes remain far inferior to those observed in temporal lobe epilepsies, possibly due to inherent difficulties in delineating and subsequently completely resecting responsible epileptogenic regions. In this study, the authors review their institutional experience with the surgical management of FLE and attempt to find predictors that may help to improve seizure outcome in this population. METHODS All surgically treated cases of intractable FLE from 1990 to 2008 were reviewed. Demographic information, preoperative and intraoperative imaging and electrophysiological investigations, and follow-up seizure outcome were assessed. Inferential statistics were performed to look for potential predictors of seizure outcome. RESULTS Forty patients (20 male, 20 female) underwent surgical management of FLE during the study period. Patients were an average of 5.6 years old at the time of FLE onset and 11.7 years at the time of surgery; patients were followed for a mean of 40.25 months. Most patients displayed typical FLE semiology. Twenty-eight patients had discrete lesions identified on MRI. Eight patients underwent 2 operations. Cortical dysplasia was the most common pathological diagnosis. Engel Class I outcome was obtained in 25 patients (62.5%), while Engel Class II outcome was observed in 5 patients (12.5%). No statistically significant predictors of outcome were found. CONCLUSIONS Control of FLE remains a challenging problem. Favorable seizure outcome, obtained in 62% of patients in this series, is still not as easily obtained in FLE as it is in temporal lobe epilepsy. While no statistically significant predictors of seizure outcome were revealed in this study, patients with FLE continue to require extensive workup and investigation to arrive at a logical and comprehensive neurosurgical treatment plan. Future studies with improved neuroimaging and advanced invasive monitoring strategies may well help define factors for success in this form of epilepsy that is difficult to control.
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Affiliation(s)
- Shobhan Vachhrajani
- Divisions of Pediatric Neurosurgery, The Hospital for Sick Children, The University of Toronto, Ontario, Canada
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31
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Abstract
Positron emission tomography (PET) has been widely used in the study of seizure disorders. As a research tool, PET has been used to determine the pathophysiology of different seizures disorders, prognostic and diagnostic information, and the response to various interventions. PET imaging has also been used clinically to help with the detection of seizure foci. With the continued development of a large array of radiopharmaceuticals that can evaluate all of the components of different neurotransmitter systems as well as cerebral blood flow and metabolism, PET imaging will continue to play a key role in research and clinical applications for seizure disorders.
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Affiliation(s)
- Abass Alavi
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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32
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Affiliation(s)
- Sebastian Bauer
- Department of Neurology, UKGM Marburg, Philipps University, Marburg, Germany.
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33
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Kumar A, Semah F, Chugani HT, Theodore WH. Epilepsy diagnosis: positron emission tomography. HANDBOOK OF CLINICAL NEUROLOGY 2012; 107:409-24. [PMID: 22938986 DOI: 10.1016/b978-0-444-52898-8.00026-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Ajay Kumar
- Department of Pediatrics & Neurology, Children's Hospital of Michigan, Detroit, MI, USA
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34
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Abstract
An estimated 10% to 40% of children with epilepsy have treatment-resistant epilepsy. Persistent seizures have negative psychosocial, behavioral, cognitive, and financial consequences and are associated with an increased mortality rate. Accurate syndromic and etiologic diagnoses are of vital importance because they may guide medical and/or surgical decision making. Revisitation of the history to confirm the diagnosis of epilepsy and the appropriateness of medication trials to date is vital. Routine imaging should include structural magnetic resonance imaging (MRI) with an established epilepsy protocol. In the setting of a normal previous MRI, repeat imaging may be indicated and may be supplemented with other imaging modalities. The admission for prolonged inpatient video-encephalographic monitoring may lead to a revision of a pre-existing diagnosis. Laboratory evaluations should include genetic, metabolic, and infectious/inflammatory studies when indicated. In this review, we discuss the implication of seizure semiology and syndrome classification when searching for an underlying diagnosis in treatment-resistant epilepsy, and will review both basic and more advanced procedures/studies that may aid diagnosis.
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Affiliation(s)
- Karen L Skjei
- Pediatric Regional Epilepsy Program, Division of Neurology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, USA.
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35
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Widjaja E, Mahmoodabadi SZ, Snead OC, Almehdar A, Smith ML. Widespread cortical thinning in children with frontal lobe epilepsy. Epilepsia 2011; 52:1685-91. [PMID: 21627647 DOI: 10.1111/j.1528-1167.2011.03085.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Elysa Widjaja
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.
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36
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Presurgical epilepsy localization with interictal cerebral dysfunction. Epilepsy Behav 2011; 20:194-208. [PMID: 21257351 DOI: 10.1016/j.yebeh.2010.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 12/07/2010] [Indexed: 11/22/2022]
Abstract
Localization of interictal cerebral dysfunction with 2-[(18)F]fluoro-2-D-deoxyglucose (FDG) positron emission tomography (PET) and neuropsychological examination usefully supplements electroencephalography (EEG) and brain magnetic resonance imaging (MRI) in planning epilepsy surgery. In MRI-negative mesial temporal lobe epilepsy, correlation of temporal lobe hypometabolism with extracranial ictal EEG can support resection without prior intracranial EEG monitoring. In refractory localization-related epilepsies, hypometabolic sites may supplement other data in hypothesizing likely ictal onset zones in order to intracranial electrodes for ictal recording. Prognostication of postoperative seizure freedom with FDG PET appears to have greater positive than negative predictive value. Neuropsychological evaluation is critical to evaluating the potential benefit of epilepsy surgery. Cortical deficits measured with neuropsychometry are limited in lateralizing and localizing value for determination of ictal onset sites, however. Left temporal resection risks iatrogenic verbal memory deficits and dysnomia, and neuropsychological findings are useful in predicting those at greatest risk. Prognostication of cognitive risks with resection at other sites is less satisfactory.
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37
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Mazzuca M, Jambaque I, Hertz-Pannier L, Bouilleret V, Archambaud F, Caviness V, Rodrigo S, Dulac O, Chiron C. 18F-FDG PET Reveals Frontotemporal Dysfunction in Children with Fever-Induced Refractory Epileptic Encephalopathy. J Nucl Med 2010; 52:40-7. [DOI: 10.2967/jnumed.110.077214] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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38
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Kumar A, Juhász C, Asano E, Sood S, Muzik O, Chugani HT. Objective detection of epileptic foci by 18F-FDG PET in children undergoing epilepsy surgery. J Nucl Med 2010; 51:1901-7. [PMID: 21078805 DOI: 10.2967/jnumed.110.075390] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
UNLABELLED PET has been used for the presurgical localization of epileptic foci for more than 20 y; still, its clinical role in children with intractable epilepsy remains unclear, largely because of variable analytic approaches and different outcome measures. The purpose of the present study was to evaluate and optimize the performance (lateralization and lobar localization value of epileptic foci) of objective voxel-based analysis of (18)F-FDG PET scans in a pediatric epilepsy population. METHODS Twenty children with intractable focal epilepsy (mean age ± SD, 11 ± 4 y; age range, 6-18 y) who underwent interictal (18)F-FDG PET, followed by 2-stage epilepsy surgery with chronic subdural electrocorticographic monitoring, and were seizure-free after surgery were included in this study. PET images were analyzed using both a visual-analysis and a statistical parametric mapping (SPM) method. Lateralization value and performance of lobar localization (in lateral and medial surfaces of all lobes, total of 8 regions in each epileptic hemisphere), calculated for 3 different statistical thresholds, were determined against intracranial electrocorticography-determined seizure-onset region and surgical resection site. RESULTS SPM using a statistical threshold of P less than 0.001 provided 100% correct lateralization, which was better than visual assessment (90%). Although visual and SPM analyses (with both P < 0.001 and P < 0.0001 thresholds) performed similarly well (with a sensitivity and specificity of 74% or above) in the localization of seizure-onset regions, SPM detected 7 of 9 seizure-onset regions, mostly in medial cortices, that were missed by visual assessment. Also, SPM performed equally well in both hemispheres, compared with visual analysis, which performed better in the left hemisphere. No statistical difference in performance was observed between visual and SPM analyses of children with abnormal versus normal MRI findings or of children with gliosis versus developmental pathology. Clinical variables, such as age, duration of epilepsy, age of seizure onset, and time between PET and last seizure, showed no correlation with sensitivity or specificity of either visual analysis or SPM analysis. CONCLUSION SPM analysis, using a young adult control group, can be used as a complementary objective analytic method in identifying epileptogenic lobar regions by (18)F-FDG PET in children older than 6 y.
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Affiliation(s)
- Ajay Kumar
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
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39
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Abstract
Positron emission tomography (PET) imaging has been widely used in the evaluation and management of patients with seizure disorders. The ability of PET to measure cerebral function makes it ideal for studying the neurophysiologic correlates of seizure activity during ictal and interictal states. PET imaging is also useful for evaluating patients before surgical interventions to determine the best surgical method and maximize outcomes. Thus, PET will continue to play a major role not only in the clinical arena but in further investigations of the pathogenesis and management of various seizure disorders. This article reviews the literature regarding the current uses and indications for PET in the study and management of patients with seizure disorders.
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Affiliation(s)
- Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 110 Donner Building, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Andrew B Newberg
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 110 Donner Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
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40
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Abstract
Positron emission tomography (PET) is a relatively noninvasive imaging test that is able to detect abnormalities in different organs based on derangements in the chemical functions and/or receptor expression at the cellular level. PET imaging of the brain has been shown to be a powerful diagnostic tool for detecting neurochemical abnormalities associated with various neurologic disorders as well as to study normal brain development. Although its use in detecting neurological abnormalities has been well described in adults and pediatrics, its application in the newborn nursery has not been explored adequately. Early detection of brain injury secondary to intrauterine and perinatal insults using PET imaging can provide new insight in prognosis and in instituting early therapy. In this review, the authors describe applications of PET imaging in the newborn nursery specifically related to the detection of metabolic changes seen in hypoxic ischemic encephalopathy, neonatal seizures, and neuroinflammation in the neonatal period.
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Affiliation(s)
- Sujatha Kannan
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
| | - Harry T. Chugani
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan,Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan,The PET Center Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
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Alkonyi B, Juhász C, Muzik O, Asano E, Saporta A, Shah A, Chugani HT. Quantitative brain surface mapping of an electrophysiologic/metabolic mismatch in human neocortical epilepsy. Epilepsy Res 2009; 87:77-87. [PMID: 19734012 DOI: 10.1016/j.eplepsyres.2009.08.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 08/03/2009] [Accepted: 08/05/2009] [Indexed: 11/25/2022]
Abstract
The spatial relationship between an intracranial EEG-defined epileptic focus and cortical hypometabolism on glucose PET has not been precisely described. In order to quantitatively evaluate the hypothesis that ictal seizure onset and/or rapid seizure propagation, detected by subdural EEG monitoring, commonly involves normometabolic cortex adjacent to hypometabolic cortical regions, we applied a novel, landmark-constrained conformal mapping approach in 14 children with refractory neocortical epilepsy. The 3D brain surface was parcellated into finite cortical elements (FCEs), and hypometabolism was defined using lobe- and side-specific asymmetry indices derived from normal adult controls. The severity and location of hypometabolic areas vs. ictal intracranial EEG abnormalities were compared on the 3D brain surface. Hypometabolism was more severe in the seizure onset zone than in cortical areas covered by non-onset electrodes. However, similar proportions of the onset electrodes were located over and adjacent to (within 2 cm) hypometabolic regions (46% vs. 41%, respectively), whereas rapid seizure spread electrodes preferred these "adjacent areas" rather than the hypometabolic area itself (51% vs. 22%). On average, 58% of the hypometabolic regions had no early seizure involvement. These findings strongly support that the seizure onset zone often extends from hypometabolic to adjacent normometabolic cortex, while large portions of hypometabolic cortex are not involved in seizure onset or early propagation. The clinical utility of FDG PET in guiding subdural electrode placement in neocortical epilepsy could be greatly enhanced by extending grid coverage to at least 2 cm beyond hypometabolic cortex, when feasible.
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Affiliation(s)
- Bálint Alkonyi
- Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
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Villeneuve N, Pinton F, Bahi-Buisson N, Dulac O, Chiron C, Nabbout R. The ketogenic diet improves recently worsened focal epilepsy. Dev Med Child Neurol 2009; 51:276-81. [PMID: 19191829 DOI: 10.1111/j.1469-8749.2008.03216.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM We observed a dramatic response to the ketogenic diet in several patients with highly refractory epilepsy whose seizure frequency had recently worsened. This study aimed to identify whether this characteristic was a useful indication for the ketogenic diet. METHOD From the 70 patients who received the ketogenic diet during a 3-year period at our institution, we retrospectively selected patients with focal epilepsy. There were 22 children, 13 females and nine males, aged from 5 months to 18 years 6 months (mean 6y 9mo, SD 5y 11mo). Fifteen had symptomatic and seven had cryptogenic focal epilepsy. Seizure frequency 1 week before initiating the ketogenic diet was compared with that at 1 month and at the last visit on the diet. RESULTS Eleven patients were responders (defined as reduction of seizures by more than 50%) at 1 month. Responders were higher (p=0.046) in the group with a recent worsening of seizures than in those with stable seizure frequency. Seven patients were still seizure-free at 6 months on the diet. Tolerability was excellent in 10 patients. Five patients stopped the diet because of early side effects. INTERPRETATION The ketogenic diet may be a valuable therapeutic option for children with pharmacoresistant focal epilepsy, particularly those with a recent deterioration of seizure control and neurological status. Because of its rapid effect, the ketogenic diet may be a useful support to intravenous emergency drugs in such a situation.
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Seizure source localization using a hybrid second order blind identification and extended rival penalized competitive learning algorithm. Biomed Signal Process Control 2009. [DOI: 10.1016/j.bspc.2009.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Trottier S, Landré E, Biraben A, Chassoux F, Pasnicu A, Scarabin JM, Turak B, Devaux B. [On the best strategies on the best results for surgery of frontal epilepsy]. Neurochirurgie 2008; 54:388-98. [PMID: 18462763 DOI: 10.1016/j.neuchi.2008.02.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 02/25/2008] [Indexed: 12/26/2022]
Abstract
Frontal lobe epilepsy surgery is the second most common surgery performed for drug-resistant partial epilepsy. We investigated the longitudinal outcome in a cohort of patients investigated since 1990 with SEEG and modern diagnostic techniques. We reviewed 105 patients who underwent surgery between 1990 and 2005 (mean follow-up, six years; range: one to 17 years) and analyzed the year-per-year follow-up according to Engel's classification. Favorable outcome (Class I) was observed for 70% and this result was stable at least five years after surgery. More than 90% of patients with lesion-related epilepsies (focal cortical dysplasia and dysembryoplastic neuroepithelial tumors) became seizure-free. Less than 50% of patients classified as having cryptogenic epilepsy (defined as normal imaging and neuropathology on surgical specimen) had a favorable outcome. Permanent neurological sequelae were subtle and rare, especially after surgery for dysplasia in eloquent cortex (primary motor cortex). Our data indicate that frontal surgery is a successful treatment in patients when electrophysiological and morphological investigations demonstrate a well-defined epileptogenic zone or lesion to be surgically resected. Progress in electrophysiological and brain-imaging techniques will further improve the selection of frontal lobe epilepsy surgery candidates.
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Affiliation(s)
- S Trottier
- Service de neurochirurgie, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France. suzanne.trottier.fr
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Tomographie par émission de positons (TEP) : quelles indications, quels bénéfices ? Neurochirurgie 2008; 54:219-25. [DOI: 10.1016/j.neuchi.2008.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 02/22/2008] [Indexed: 11/23/2022]
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Luat AF, Asano E, Rothermel R, Sood S, Chugani HT. Psychosis as a manifestation of frontal lobe epilepsy. Epilepsy Behav 2008; 12:200-4. [PMID: 17981091 DOI: 10.1016/j.yebeh.2007.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 08/31/2007] [Accepted: 09/05/2007] [Indexed: 10/22/2022]
Abstract
A 7-year-old girl presented with a cluster of seizures occurring in one day and followed by the development of paranoid delusions. Her electroencephalogram (EEG) revealed a psychomotor variant. Cranial MRI was normal, but the 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG) positron emission tomography (PET) scan showed hypometabolism in the left inferior frontal cortex. Her psychotic symptoms occurred episodically. Three years later, she developed hypermotor seizures associated with a fearful look. Video/EEG monitoring captured seizures of left frontotemporal onset. Her seizures became drug resistant and she underwent epilepsy surgery. Intracranial electrocorticography captured spontaneous and electrically induced seizures with onset in the left inferior frontal region, which was resected. She became seizure-free and her psychosis resolved. This case illustrates that frontal lobe epilepsy can present solely with psychotic symptoms, which may delay the diagnosis of epilepsy. We suggest that these cases may be underdiagnosed. When epilepsy is suspected and if MRI fails to demonstrate an abnormality, FDG PET scanning and video/EEG monitoring should be considered.
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Affiliation(s)
- Aimee F Luat
- Children's Hospital of Michigan-Detroit Medical Center/Wayne State University, Detroit, MI 48201, USA
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Patil S, Biassoni L, Borgwardt L. Nuclear Medicine in Pediatric Neurology and Neurosurgery: Epilepsy and Brain Tumors. Semin Nucl Med 2007; 37:357-81. [PMID: 17707242 DOI: 10.1053/j.semnuclmed.2007.04.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In pediatric drug-resistant epilepsy, nuclear medicine can provide important additional information in the presurgical localization of the epileptogenic focus. The main modalities used are interictal (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) and ictal regional cerebral perfusion study with single-photon emission computed tomography (SPECT). Nuclear medicine techniques have a sensitivity of approximately 85% to 90% in the localization of an epileptogenic focus in temporal lobe epilepsy; however, in this clinical setting, they are not always clinically indicated because other techniques (eg, icterictal and ictal electroencephalogram, video telemetry, magnetic resonance imaging [MRI]) may be successful in the identification of the epileptogenic focus. Nuclear medicine is very useful when MRI is negative and/or when electroencephalogram and MRI are discordant. A good technique to identify the epileptogenic focus is especially needed in the setting of extra-temporal lobe epilepsy; however, in this context, identification of the epileptogenic focus is more difficult for all techniques and the sensitivity of the isotope techniques is only 50% to 60%. This review article discusses the clinical value of the different techniques in the clinical context; it also gives practical suggestions on how to acquire good ictal SPECT and interictal FDG-PET scans. Nuclear medicine in pediatric brain tumors can help in differentiating tumor recurrence from post-treatment sequelae, in assessing the response to treatment, in directing biopsy, and in planning therapy. Both PET and SPECT tracers can be used. In this review, we discuss the use of the different tracers available in this still very new, but promising, application of radioisotope techniques.
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Affiliation(s)
- Shekhar Patil
- University College London-Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust and the National Centre for Young People with Epilepsy, London, United Kingdom
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Sood S, Chugani HT. Functional neuroimaging in the preoperative evaluation of children with drug-resistant epilepsy. Childs Nerv Syst 2006; 22:810-20. [PMID: 16799821 DOI: 10.1007/s00381-006-0137-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Indexed: 10/24/2022]
Abstract
UNLABELLED FUNCTIONAL NEUROIMAGING: Although the primary imaging modality in the management of epilepsy is magnetic resonance imaging MRI, functional neuroimaging with positron-emission tomography (PET) and single photon emission computed tomography (SPECT) often provides complementary information and, in a number of situations, provides unique information that cannot be obtained with MRI. The most commonly used PET tracers used for epilepsy evaluation are 2-deoxy-2-[(18)F]fluoro-D: -glucose (FDG) and [(11)C]flumazenil (FMZ). Recently, interictal PET with alpha-[(11)C]methyl-L: -tryptophan was found to be highly specific for the epileptic focus and can differentiate between epileptogenic and nonepileptogenic lesions in the same patient (e.g., in patients with tuberous sclerosis). DISCUSSION In this review, we discuss clinical applications of these three PET tracers in drug-resistant temporal and extratemporal lobe epilepsy, selected epilepsy syndromes of childhood, lesional and nonlesional epilepsy, and the challenges of imaging secondary epileptic foci. A brief discussion of SPECT applications in epilepsy is also included. With further development of new tracers highly sensitive and specific for epileptogenic brain regions, the presurgical evaluation of refractory epilepsy will be greatly facilitated. Approximately 0.5 to 1.0% of the population suffer from epilepsy, of which 15-20% are intractable. Infants and children, whose seizures have a focal onset are refractory to anticonvulsants and are prolonged, tend to have the worst cognitive outcome [Meador KJ, Neurology 58 (Suppl 5):S21-S26, 2002]. Seizures themselves affect the developing brain and contribute to an adverse neurologic outcome (Holmes, Pediatric Neurology 33:1-110, 2005). CONCLUSION Therefore, in treating children with intractable epilepsy, it is important to consider seizure control and to give allowance for normal cognitive development.
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Affiliation(s)
- Sandeep Sood
- Department of Neurosurgery, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA
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