Nuclear imaging for localization and surgical outcome prediction in epilepsy: A review of latest discoveries and future perspectives

Abstract

BackgroundEpilepsy is one of the most common neurological disorders. Approximately, one-third of patients with epilepsy have seizures refractory to antiepileptic drugs and further require surgical removal of the epileptogenic region. In the last decade, there have been many recent developments in radiopharmaceuticals, novel image analysis techniques, and new software for an epileptogenic zone (EZ) localization.ObjectivesRecently, we provided the latest discoveries, current challenges, and future perspectives in the field of positron emission tomography (PET) and single-photon emission computed tomography (SPECT) in epilepsy.MethodsWe searched for relevant articles published in MEDLINE and CENTRAL from July 2012 to July 2022. A systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis was conducted using the keywords “Epilepsy” and “PET or SPECT.” We included both prospective and retrospective studies. Studies with preclinical subjects or not focusing on EZ localization or surgical outcome prediction using recently developed PET radiopharmaceuticals, novel image analysis techniques, and new software were excluded from the review. The remaining 162 articles were reviewed.ResultsWe first present recent findings and developments in PET radiopharmaceuticals. Second, we present novel image analysis techniques and new software in the last decade for EZ localization. Finally, we summarize the overall findings and discuss future perspectives in the field of PET and SPECT in epilepsy.ConclusionCombining new radiopharmaceutical development, new indications, new techniques, and software improves EZ localization and provides a better understanding of epilepsy. These have proven not to only predict prognosis but also to improve the outcome of epilepsy surgery.

Tracing topics and trends in drug‐resistant epilepsy research using a natural language processing–based topic modeling approach

“…On the other hand, functional brain mapping has emerged as a cornerstone in understanding neural circuitry and its implications in DRE 42 . With the advent of advanced neuroimaging techniques such as functional magnetic resonance imaging (fMRI), 43 positron emission tomography (PET), 44 and magnetoencephalography (MEG), 45 both clinicians and researchers have been able to visualize and track real‐time brain activity. These technologies allow for the identification of the specific brain regions and networks involved in seizure genesis, propagation, and termination.…”

Hypometabolic patterns of focal cortical dysplasia in PET-MRI co-registration imaging: a retrospective evaluation in a series of 83 patients

“…Fourthly, other presurgical evaluation information, including seizure semiology and EEG, were not analyzed together with imaging analysis, which are important predictors for surgical outcomes. Lastly, While FDG-PET is used in clinical practice for epilepsy surgery, PET with other specific ligands, including the AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid) receptors ( Sukprakun and Tepmongkol, 2022 ) and [(11)C] flumazenil (FMZ; Hodolic et al, 2016 ), may provide further Supplementary information for FCD localization.…”

“…Accordingly, the co-registration of PET and structural MRI images could not only improve the sensitivity of FCD detection but also clearly and precisely delineate the FCD in the preoperative evaluation prior to epilepsy surgery. According to the hypometabolic area of PET-MRI co-registration, the epileptogenic lesions were strictly co-localized with the focalized hypometabolic areas, especially in FCD type II ( Chassoux et al, 2010 ; Sukprakun and Tepmongkol, 2022 ); while in temporal lobe FCD, the hypometabolic areas were usually larger than the actual lesions ( Yokota et al, 2020 ). Thus we proposed that the extension of the hypometabolic area might be correlated with the FCD subtypes and other anatomical factors.…”

Analysis of the performance of PET/CT using 18F-fluorodeoxyglucose in comparison with other diagnostic methods in drug-resistant epilepsy in children

“…Медикаментозне лікування епілепсії має суто симптоматичний характер. Ефективність цих препаратів може бути обмежена нездатністю долати гематоенцефалічний бар'єр, що є потенційним підґрунтям для розвитку резистентності до ліків при епілепсії [1,9,10].…”

“…У наш час доведено, що успіх хірургічного втручання залежить від точного визначення епілептогенного вогнища, незалежно від того, чи воно очевидно анатомічне, чи функціональне [6,13]. Епілептогенна зона визначена як «мінімальна кількість кори головного мозку, яку необхідно резектувати (інактивувати або повністю від'єднати), щоб отримати звільнення від нападу» [9,14]. Щоб прийняти рішення про операцію з приводу епілепсії, пацієнти повинні пройти серію тестів у рамках звичайної стандартної передопераційної оцінки, щоб визначити передбачувану епілептогенну зону і кандидатів на хірургічне втручання [14,15].…”