Correlation of <scp>FDG</scp>‐<scp>PET</scp> hypometabolism and <scp>SEEG</scp> epileptogenicity mapping in patients with drug‐resistant focal epilepsy

Lamarche, Florence; Job, Anne‐Sophie; Deman, Pierre; Bhattacharjee, Manik; Hoffmann, D.; Gallazzini-Crepin, C.; Bouvard, Sandrine; Minotti, Lorella; Kahane, Philippe; David, Olivier

doi:10.1111/epi.13592

Cited by 41 publications

(35 citation statements)

References 33 publications

(82 reference statements)

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“…A recent study, using stereo-EEG, also found a poor correlation between hypometabolic cortex and iHFOs in patients with extratemporal seizure foci [Lamarche et al, 2016]. Despite the different PET analytic approaches, both those previous and our current results demonstrated a mismatch between hypometabolic and epileptogenic cortex, which appears to be present regardless of age or epilepsy duration.…”

Section: Discussioncontrasting

confidence: 47%

“…Two previous studies from our group have used an asymmetry-based approach to compare the performance of FDG-PET against ECoG-defined SOZ in small pediatric groups with epilepsy surgery [Alkonyi et al, 2009;Juh asz et al, 2000]. A recent study, using stereo-EEG, also found a poor correlation between hypometabolic cortex and iHFOs in patients with extratemporal seizure foci [Lamarche et al, 2016]. Despite the different PET analytic approaches, both those previous and our current results demonstrated a mismatch between hypometabolic and epileptogenic cortex, which appears to be present regardless of age or epilepsy duration.…”

Section: Discussionmentioning

confidence: 98%

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Objective 3D surface evaluation of intracranial electrophysiologic correlates of cerebral glucose metabolic abnormalities in children with focal epilepsy

Jeong

Asano

Pilli

et al. 2017

Human Brain Mapping

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To determine the spatial relationship between 2-deoxy-2[18F]fluoro-D-glucose (FDG) metabolic and intracranial electrophysiological abnormalities in children undergoing two-stage epilepsy surgery, we used statistical parametric mapping (SPM) 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 to 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 3cm beyond hypometabolic regions with the same statistical threshold (sensitivity/specificity=0.18–0.25/0.94–0.90 for overlap-3cm distance); for a lower threshold, sensitivity for SOZ at 3cm increased to 0.39 with a modest compromise of specificity. Performance of FDG-PET SPM was slightly better in children with smaller as compared to 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 3cm 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.

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Section: Discussioncontrasting

confidence: 47%

Section: Discussionmentioning

confidence: 98%

Objective 3D surface evaluation of intracranial electrophysiologic correlates of cerebral glucose metabolic abnormalities in children with focal epilepsy

Jeong

Asano

Pilli

et al. 2017

Human Brain Mapping

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“…Among 490 SEEG-informed patients who underwent resective surgery from nine studies, 310 patients (61.0%, 95% CI = 60.5-61.4%) were seizure-free. 15,16,22,23,27,28,32,33,49 Of the 953 SDE-informed patients who underwent resective surgery from 21 studies, 564 patients (56.4%, 95% CI = 55.7-57.1%) were seizurefree. 18,20,21,24,25,[35][36][37][38][39][40][41][42][43][44][45]47,48,[50][51][52] Therefore, SEEG-informed surgical resections have associations that suggest better seizure freedom outcomes than SDE-informed surgical resections (WMD = +5.8%, 95% CI = 4.7-6.9%, P = .001).…”

Section: Epileptic Surgery and Outcomesmentioning

confidence: 99%

Method of invasive monitoring in epilepsy surgery and seizure freedom and morbidity: A systematic review

et al. 2019

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Objective Invasive monitoring is sometimes necessary to guide resective surgery in epilepsy patients, but the ideal method is unknown. In this systematic review, we assess the association of postresection seizure freedom and adverse events in stereoelectroencephalography (SEEG) and subdural electrodes (SDE). Methods We searched three electronic databases (MEDLINE, Embase, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to January 2018 with the keywords “electroencephalography,” “intracranial grid,” and “epilepsy.” Studies that presented primary quantitative patient data for postresection seizure freedom with at least 1 year of follow‐up or complication rates of SEEG‐ or SDE‐monitored patients were included. Two trained investigators independently collected data from eligible studies. Weighted mean differences (WMDs) with 95% confidence interval (CIs) were used as a measure of the association of SEEG or SDE with seizure freedom and with adverse event outcomes. Results Of 11 462 screened records, 48 studies met inclusion criteria. These studies reported on 1973 SEEG patients and 2036 SDE patients. Our systematic review revealed SEEG was associated with 61.0% and SDE was associated with 56.4% seizure freedom after resection (WMD = +5.8%, 95% CI = 4.7‐6.9%, P = .001). Furthermore, SEEG was associated with 4.8% and SDE was associated with 15.5% morbidity (WMD = −10.6%, 95% CI = −11.6 to −9.6%, P = .001). SEEG was associated with 0.2% mortality and SDE was associated with 0.4% mortality (WMD = −0.2%, 95% CI = −0.3 to −0.1%, P = .001). Significance In this systematic review of SEEG and SDE invasive monitoring techniques, SEEG was associated with fewer surgical resections yet better seizure freedom outcomes in those undergoing resections. SEEG was also associated with lower mortality and morbidity than SDE. Clinical studies directly comparing these modalities are necessary to understand the relative rates of seizure freedom, morbidity, and mortality associated with these techniques.

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“…[3][4][5][6] The costefficiency of 18 FDG-PET has long been recognized, and the wider availability of postacquisition processing techniques has increased its yield in surgical planning. 17,18 Furthermore, the findings of recent 18 FDG-PET and functional connectivity studies have been convergent in demonstrating the role of 18 FDG-PET as a metabolic biomarker of the extent of the epileptic network dysfunction. [12][13][14][15][16] There has been a growing body of evidence suggesting that the extent of the metabolic compromise correlates with the distribution of ictal EEG discharges.…”

mentioning

confidence: 93%

“…[12][13][14][15][16] There has been a growing body of evidence suggesting that the extent of the metabolic compromise correlates with the distribution of ictal EEG discharges. 17,18 Furthermore, the findings of recent 18 FDG-PET and functional connectivity studies have been convergent in demonstrating the role of 18 FDG-PET as a metabolic biomarker of the extent of the epileptic network dysfunction. 19,20 It has also been suggested that hypometabolic changes affecting the contralateral (CTL) temporal lobe (TL) may impact on seizure outcomes in patients with drug-resistant MTLE.…”

mentioning

confidence: 93%

Metabolic patterns and seizure outcomes following anterior temporal lobectomy

Cahill

Sinclair

Malpas

et al. 2019

Annals of Neurology

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Objective: We investigated the relationship between the interictal metabolic patterns, the extent of resection of 18 Ffluorodeoxyglucose positron emission tomography ( 18 FDG-PET) hypometabolism, and seizure outcomes in patients with unilateral drug-resistant mesial temporal lobe epilepsy (MTLE) following anterior temporal lobe (TL) resection. Methods: Eighty-two patients with hippocampal sclerosis or normal magnetic resonance imaging (MRI) findings, concordant 18 FDG-PET hypometabolism, and at least 2 years of postoperative follow-up were included in this 2-center study. The hypometabolic regions in each patient were identified with reference to 20 healthy controls (p < 0.005). The resected TL volume and the volume of resected TL PET hypometabolism (TLH) were calculated from the pre-and postoperative MRI scans coregistered with interictal 18 FDG-PET. Results: Striking differences in metabolic patterns were observed depending on the lateralization of the epileptogenic TL. The extent of the ipsilateral TLH was significantly greater in left MTLE patients (p < 0.001), whereas right MTLE patients had significantly higher rates of contralateral (CTL) TLH (p = 0.016). In right MTLE patients, CTL hypometabolism was the strongest predictor of an unfavorable seizure outcome, associated with a 5-fold increase in the likelihood of seizure recurrence (odds ratio [OR] = 4.90, 95% confidence interval [CI] = 1.07-22.39, p = 0.04). In left MTLE patients, greater extent of resection of ipsilateral TLH was associated with lower rates of seizure recurrence (p = 0.004) in univariate analysis; however, its predictive value did not reach statistical significance (OR = 0.96, 95% CI = 0.90-1.02, p = 0.19). Interpretation: The difference in metabolic patterns depending on the lateralization of MTLE may represent distinct epileptic networks in patients with right versus left MTLE, and can guide preoperative counseling and surgical planning.

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Correlation of FDG‐PET hypometabolism and SEEG epileptogenicity mapping in patients with drug‐resistant focal epilepsy

Cited by 41 publications

References 33 publications

Objective 3D surface evaluation of intracranial electrophysiologic correlates of cerebral glucose metabolic abnormalities in children with focal epilepsy

Objective 3D surface evaluation of intracranial electrophysiologic correlates of cerebral glucose metabolic abnormalities in children with focal epilepsy

Method of invasive monitoring in epilepsy surgery and seizure freedom and morbidity: A systematic review

Metabolic patterns and seizure outcomes following anterior temporal lobectomy

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