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Quantitative [18]FDG PET asymmetry features predict long-term seizure recurrence in refractory epilepsy. Epilepsy Behav 2021; 116:107714. [PMID: 33485794 PMCID: PMC8344068 DOI: 10.1016/j.yebeh.2020.107714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/02/2020] [Accepted: 12/12/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Fluorodeoxyglucose-positron emission tomography (FDG-PET) is an established, independent, strong predictor of surgical outcome in refractory epilepsy. In this study, we explored the added value of quantitative [18F]FDG-PET features combined with clinical variables, including electroencephalography (EEG), [18F]FDG-PET, and magnetic resonance imaging (MRI) qualitative interpretations, to predict long-term seizure recurrence (mean post-op follow-up of 5.85 ± 3.77 years). METHODS Machine learning predictive models of surgical outcome were created using a random forest classifier trained on quantitative features in 89 patients with drug-refractory temporal lobe epilepsy evaluated at the Hospital of the University of Pennsylvania epilepsy surgery program (2003-2016). Quantitative features were calculated from asymmetry features derived from image processing using Advanced Normalization Tools (ANTs). RESULTS The best-performing model used quantification and had an out-of-bag accuracy of 0.71 in identifying patients with seizure recurrence (Engel IB or worse) which outperformed that using qualitative clinical data by 10%. This model is shared through open-source software for research use. In addition, several asymmetry features in temporal and extratemporal regions that were significantly associated with seizure freedom are identified for future study. SIGNIFICANCE Complex quantitative [18F]FDG-PET imaging features can predict seizure recurrence in patients with refractory temporal lobe epilepsy. These initial retrospective results in a cohort with long-term follow-up suggest that using quantitative imaging features from regions in the epileptogenic network can inform the clinical decision-making process.
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Jaisani Z, Miletich RS, Ramanathan M, Weinstock AL. Clinical FDG‐PET Findings in Patients with Temporal Lobe Epilepsy: Concordance with EEG and MRI. J Neuroimaging 2019; 30:119-125. [DOI: 10.1111/jon.12671] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 01/15/2023] Open
Affiliation(s)
- Zeenat Jaisani
- Department of NeurologyUniversity of Alabama at Birmingham (UAB) Birmingham AL
| | - Robert S. Miletich
- Department of Nuclear MedicineUniversity at Buffalo, Jacobs School of Medicine and Biomedical Sciences Buffalo NY
| | - Murali Ramanathan
- Department of Pharmacological SciencesUniversity at Buffalo Buffalo NY
| | - Arie L. Weinstock
- Department of NeurologyUniversity at Buffalo, Jacobs School of Medicine and Biomedical Sciences Buffalo NY
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Continuous ictal discharges with high frequency oscillations confined to the non-sclerotic hippocampus in an epileptic patient with radiation-induced cavernoma in the lateral temporal lobe. EPILEPSY & BEHAVIOR CASE REPORTS 2019; 11:87-91. [PMID: 30792954 PMCID: PMC6370593 DOI: 10.1016/j.ebcr.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 11/20/2022]
Abstract
Background Intraoperative electrocorticography (iECoG) recording is recommended for treating cavernoma related epilepsy. However, "interictal" paroxysmal activities are generally recordable but are not always identical to the epileptogenic zone. Case description We surgically treated a 15-year-old girl with drug-resistant epilepsy associated with radiation-induced cavernoma in the right lateral temporal lobe. iECoG revealed paroxysmal activities in the cortex around the cavernoma. Additionally, continuous subclinical "ictal" discharges with high-frequency oscillations (HFO), confined to the histologically non-sclerotic hippocampus, were recorded. Following additional hippocampectomy, a good seizure outcome was obtained. Conclusion iECoG and HFO analysis revealed high epileptogenicity in the non-sclerotic hippocampus of this patient.
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Imaging correlates of behavioral impairments: An experimental PET study in the rat pilocarpine epilepsy model. Neurobiol Dis 2018; 118:9-21. [DOI: 10.1016/j.nbd.2018.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/05/2018] [Accepted: 06/12/2018] [Indexed: 01/04/2023] Open
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Knopman AA, Wong CH, Stevenson RJ, Homewood J, Mohamed A, Somerville E, Eberl S, Wen L, Fulham M, Bleasel AF. The relationship between neuropsychological functioning and FDG-PET hypometabolism in intractable mesial temporal lobe epilepsy. Epilepsy Behav 2015; 44:136-42. [PMID: 25703620 DOI: 10.1016/j.yebeh.2015.01.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 11/17/2022]
Abstract
We examined the relationship between baseline neuropsychological functioning and 18-fluorodeoxyglucose positron emission tomography (FDG-PET) in intractable mesial temporal lobe epilepsy (MTLE). We hypothesized relationships between dominant temporal lobe hypometabolism and verbal memory and between nondominant temporal lobe hypometabolism and nonverbal memory in line with the lateralized material-specific model of memory deficits in MTLE. We also hypothesized an association between performance on frontal lobe neuropsychological tests and prefrontal hypometabolism. Thirty-two patients who had undergone temporal lobectomy for treatment of MTLE and who completed both presurgical FDG-PET and comprehensive neuropsychological investigations with widely used standardized measures were included. Age-adjusted composite measures were calculated for verbal memory, nonverbal memory, relative material-specific memory, IQ, executive function, attention/working memory, and psychomotor speed. Fluorodeoxyglucose positron emission tomography was analyzed with statistical parametric mapping (SPM) to identify hypometabolism relative to healthy controls. Pearson's correlation was used to determine the relationship between regions of hypometabolism and neuropsychological functioning. Dominant temporal lobe hypometabolism was associated with relatively inferior verbal memory, while nondominant temporal lobe hypometabolism was associated with inferior nonverbal memory. No relationship was found between performance on any frontal lobe measures and prefrontal hypometabolism. Statistical parametric mapping-quantified lateralized temporal lobe hypometabolism correlates with material-specific episodic memory impairment in MTLE. In contrast, prefrontal hypometabolism is not associated with performance on frontal lobe measures. We suggest that this is because frontal lobe neuropsychology tests may not be good measures of isolated frontal lobe functioning.
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Affiliation(s)
- Alex A Knopman
- Department of Psychology, Macquarie University, NSW, Australia; Department of Medical Psychology, Westmead Hospital, NSW, Australia
| | - Chong H Wong
- Sydney Medical School, University of Sydney, NSW, Australia; Departments of Neurology, Westmead Hospital and The Children's Hospital at Westmead, NSW, Australia
| | | | - Judi Homewood
- Department of Psychology, Macquarie University, NSW, Australia
| | - Armin Mohamed
- Sydney Medical School, University of Sydney, NSW, Australia; Department of Molecular Imaging, Royal Prince Alfred Hospital, NSW, Australia
| | - Ernest Somerville
- Institute of Neurological Sciences, Prince of Wales Hospital, NSW, Australia; Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Stefan Eberl
- Sydney Medical School, University of Sydney, NSW, Australia; Department of Molecular Imaging, Royal Prince Alfred Hospital, NSW, Australia
| | - Lingfeng Wen
- Sydney Medical School, University of Sydney, NSW, Australia; Department of Molecular Imaging, Royal Prince Alfred Hospital, NSW, Australia
| | - Michael Fulham
- Sydney Medical School, University of Sydney, NSW, Australia; Department of Molecular Imaging, Royal Prince Alfred Hospital, NSW, Australia
| | - Andrew F Bleasel
- Sydney Medical School, University of Sydney, NSW, Australia; Departments of Neurology, Westmead Hospital and The Children's Hospital at Westmead, NSW, Australia.
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Takahashi M, Soma T, Kawai K, Koyama K, Ohtomo K, Momose T. Voxel-based comparison of preoperative FDG-PET between mesial temporal lobe epilepsy patients with and without postoperative seizure-free outcomes. Ann Nucl Med 2012; 26:698-706. [DOI: 10.1007/s12149-012-0629-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 06/24/2012] [Indexed: 11/30/2022]
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Smith SEP, Xu L, Kasten MR, Anderson MP. Mutant LGI1 inhibits seizure-induced trafficking of Kv4.2 potassium channels. J Neurochem 2012; 120:611-21. [PMID: 22122031 DOI: 10.1111/j.1471-4159.2011.07605.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Activity-dependent redistribution of ion channels mediates neuronal circuit plasticity and homeostasis, and could provide pro-epileptic or compensatory anti-epileptic responses to a seizure. Thalamocortical neurons transmit sensory information to the cerebral cortex and through reciprocal corticothalamic connections are intensely activated during a seizure. Therefore, we assessed whether a seizure alters ion channel surface expression and consequent neurophysiologic function of thalamocortical neurons. We report a seizure triggers a rapid (<2h) decrease of excitatory postsynaptic current (EPSC)-like current-induced phasic firing associated with increased transient A-type K(+) current. Seizures also rapidly redistributed the A-type K(+) channel subunit Kv4.2 to the neuronal surface implicating a molecular substrate for the increased K(+) current. Glutamate applied in vitro mimicked the effect, suggesting a direct effect of glutamatergic transmission. Importantly, leucine-rich glioma-inactivated-1 (LGI1), a secreted synaptic protein mutated to cause human partial epilepsy, regulated this seizure-induced circuit response. Human epilepsy-associated dominant-negative-truncated mutant LGI1 inhibited the seizure-induced suppression of phasic firing, increase of A-type K(+) current, and recruitment of Kv4.2 surface expression (in vivo and in vitro). The results identify a response of thalamocortical neurons to seizures involving Kv4.2 surface recruitment associated with dampened phasic firing. The results also identify impaired seizure-induced increases of A-type K(+) current as an additional defect produced by the autosomal dominant lateral temporal lobe epilepsy gene mutant that might contribute to the seizure disorder.
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Affiliation(s)
- Stephen E P Smith
- Departments of Neurology and Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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Hashiguchi K, Morioka T, Murakami N, Suzuki SO, Hiwatashi A, Yoshiura T, Sasaki T. Utility of 3-T FLAIR and 3D short tau inversion recovery MR imaging in the preoperative diagnosis of hippocampal sclerosis: direct comparison with 1.5-T FLAIR MR imaging. Epilepsia 2010; 51:1820-8. [PMID: 20738382 DOI: 10.1111/j.1528-1167.2010.02685.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the utility of fluid-attenuated inversion recovery (FLAIR) imaging and three-dimensional short tau inversion recovery (3DSTIR) imaging using a 3-Tesla (3-T) magnetic resonance (MR) imager in the preoperative evaluation of hippocampal sclerosis (HS). METHODS Thirteen patients with intractable medial temporal lobe epilepsy who underwent anterior temporal lobectomy with amygdalohippocampectomy were studied. MR images were obtained twice, once with a 1.5-T imager and once with a 3-T imager. The extent of hippocampal resection was determined according to the findings on intraoperative hippocampal electroencephalography. We compared the diagnostic utility of FLAIR for HS between 1.5-T and 3-T MR imaging. In addition, the relationship between the existence of hypointense areas in the hippocampus (HIAs) on 3DSTIR and the severity of HS pathology (as evaluated using Watson's grading) was examined. The relationship between postoperative seizure outcome and postoperatively remaining HIAs was also evaluated. RESULTS There was no difference between FLAIR images from 1.5-T and 3-T imaging in the detection of HS. With 3DSTIR, an HIA in unilateral hippocampus was observed in all of the nine cases exhibiting severe pathologic HS (Watson's grade III-V). In seven cases with HIA, the extent of hippocampal resection was smaller than the HIAs. Every case showed good seizure outcome (Engel's class I and II). DISCUSSION In the diagnosis of HS, no substantial difference was noted between 1.5-T and 3-T MR imaging. However, 3DSTIR using 3-T MR imaging is useful for evaluating the extent of HS, although postoperative HS remnants are not correlated with surgical outcomes.
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Affiliation(s)
- Kimiaki Hashiguchi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan. khash@.med.kyushu-u.ac.jp
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Wong CH, Bleasel A, Wen L, Eberl S, Byth K, Fulham M, Somerville E, Mohamed A. The topography and significance of extratemporal hypometabolism in refractory mesial temporal lobe epilepsy examined by FDG-PET. Epilepsia 2010; 51:1365-73. [DOI: 10.1111/j.1528-1167.2010.02552.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sakamoto S, Takami T, Tsuyuguchi N, Morino M, Ohata K, Inoue Y, Ide W, Hashimoto I, Kamada H, Tanaka H, Hara M. Prediction of seizure outcome following epilepsy surgery: Asymmetry of thalamic glucose metabolism and cerebral neural activity in temporal lobe epilepsy. Seizure 2009; 18:1-6. [DOI: 10.1016/j.seizure.2008.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 04/03/2008] [Accepted: 05/09/2008] [Indexed: 12/01/2022] Open
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Rosenberg DS, Mauguière F, Catenoix H, Faillenot I, Magnin M. Reciprocal Thalamocortical Connectivity of the Medial Pulvinar: A Depth Stimulation and Evoked Potential Study in Human Brain. Cereb Cortex 2008; 19:1462-73. [DOI: 10.1093/cercor/bhn185] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Morioka T, Hashiguchi K, Nagata S, Miyagi Y, Yoshida F, Shono T, Mihara F, Koga H, Sasaki T. Additional hippocampectomy in the surgical management of intractable temporal lobe epilepsy associated with glioneuronal tumor. Neurol Res 2008; 29:807-15. [PMID: 17601368 DOI: 10.1179/016164107x223566] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In surgery for epileptogenic glioneuronal tumor in the temporal lobe, whether additional hippocampectomy is needed remains in dispute. We retrospectively analysed clinical profile and seizure outcome in a consecutive series of six patients, paying special attention to pathophysiologic conditions in the ipsilateral hippocampus. Long-term video electroencephalography (EEG) monitoring showed attenuation of background activity, followed by ictal discharges in the ipsilateral temporal region in five cases. (18)Fluorodeoxyglucose-positron emission tomography (FDG-PET) in five cases showed hypometabolism in the ipsilateral medial temporal lobe. Intraoperative electrocorticography (ECoG) after removal of the tumor revealed frequent paroxysmal activity or electrographic seizure activity on the hippocampus in five cases. A high incidence of hippocampal pathology, such as hippocampal sclerosis in four cases and dysgenesis in one case, was demonstrated. Five patients who underwent additional hippocampectomy along with resection of the tumor became completely seizure-free. Our findings indicated a proclivity for the epileptogenic zone to encompass the medial structures and for hippocampal pathology to be present even when no direct medial tumor involvement was identified. Thus, it is conceivable that removal of the hippocampus with the guidance of pre- and intraoperative multimodal examinations, in addition to resection of the tumor, may be recommended to achieve 'complete' freedom from seizures.
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Affiliation(s)
- Takato Morioka
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
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Della Marca G, Vollono C, Ferraro D, Mariotti P, Mazza M, Ferini-Strambi L, Mazza S. Left thalamomegaly in a patient with partial epilepsy. Clin Neurol Neurosurg 2007; 110:298-301. [PMID: 18096311 DOI: 10.1016/j.clineuro.2007.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 10/23/2007] [Accepted: 10/27/2007] [Indexed: 11/26/2022]
Abstract
Temporal lobe epilepsy (TLE) is associated with modification in thalamic structure and function. In particular, thalamic atrophy and hypometabolism can occur, affecting ipsilateral, contralateral thalami or both. We describe a 28-year-old epileptic woman, who presented peculiar neuroimaging findings, with enlargement of the thalamus contralateral to the epileptic focus. The patient was born from dystocic delivery, she presented partial motor seizures in the left side of the body, followed by generalisation, and the EEG showed a right temporal epileptic focus. Serial CT and MRI scan, performed along 11 years, showed a non-evolutive left thalamomegaly. 18-FDG PET showed reduced metabolic activity in the upper right temporal gyrus and in the ipsilateral thalamus. Thalamic asymmetry in our patient could be an occasional finding.
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