Quantitative Analysis of Simultaneous EEG Features during PET Studies for Childhood Partial Epilepsy

Hur, Yun Jung; Lee, Joon Soo; Lee, Jong Doo; Yun, Mi Jin; Kim, Heung Dong

doi:10.3349/ymj.2013.54.3.572

Cited by 8 publications

(12 citation statements)

References 22 publications

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“…Five patients had presumed interictal focal PET hypermetabolism. We believe concomitant surface EEG during PET should be considered in the presurgical evaluation of patients suffering from frequent seizures, to better interpret the FDG-PET results, as active IEDs and prominent rhythmic activity are associated with PET hypermetabolism [24,29,31]. Our results suggest that PET hypermetabolism is more commonly associated with frequent IEDs than ictal EEG.…”

Section: Discussionmentioning

confidence: 58%

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Significance of FDG-PET Hypermetabolism in Children with Intractable Focal Epilepsy

et al. 2018

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Background: Interictal ¹⁸F-fluorodeoxyglucose-positron emission topography (FDG-PET) hypometabolism is routinely used in the presurgical workup of children with medically intractable epilepsy (MIE). FDG-PET hypermetabolism, however, is rarely seen, and the significance of this finding in the epilepsy workup is not well established. Methods: We performed a retrospective study of patients who underwent FDG-PET during the presurgical workup of MIE over a 4-year period, between 1 January 2010 and 31 December 2013, at the Children’s Hospital Colorado, CO, USA. Results: Focal FDG-PET hypermetabolism was identified in 7 (2.2%) of 317 patients. The median age was 124 months, all cases with catastrophic epilepsy. Surface electroencephalography (EEG) performed concomitantly with FDG injections revealed ictal EEG discharges in 2 patients, frequent interictal epileptiform discharges (IEDs) in 3, occasional IEDs in 1, and no IEDs in 1. All 7 patients underwent functional hemispherectomies. Histopathology revealed type 1 focal cortical dysplasia in all patients. Six (86%) were completely seizure-free (Engel class I) and 1 had extremely infrequent seizures (Engel class II) (mean follow-up, 47.4 months). Conclusion: While a rare finding, interictal PET hypermetabolism does occur, may help identify epileptogenic zones, and assessment to reveal it should be made by concomitant use of surface EEG during PET scans.

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Section: Discussionmentioning

confidence: 58%

“…A high spike count was also reported in other studies although the calculation was different [29,31]. Bansal et al [24] found FCD in all cases.…”

Section: Discussionmentioning

confidence: 63%

Significance of FDG-PET Hypermetabolism in Children with Intractable Focal Epilepsy

et al. 2018

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“…The severe group had higher values of jAIj than the mild and moderate groups, and the jAIj was positively correlated with seizure frequency in patients with hyper-or hypometabolism. Although hypermetabolism is frequently observed during the ictal state of epilepsy (32,33), it can also be observed in the absence of ictal events during tracer uptake and correlates well with regions of high spike count, suggesting a state of increased epileptogenicity (33,34). In view of the abundant sample size of patients with interictal hypermetabolism, we assume that the jAIj value on 18 F-FDG PET images in patients with hypermetabolism could be affected by the clinical severity and seizure frequency.…”

Section: Discussionmentioning

confidence: 99%

Glucose Metabolic Profile by Visual Assessment Combined with Statistical Parametric Mapping Analysis in Pediatric Patients with Epilepsy

Zhu

Feng

et al. 2017

J Nucl Med

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PET with 18 F-FDG has been used for presurgical localization of epileptogenic foci; however, in nonsurgical patients, the correlation between cerebral glucose metabolism and clinical severity has not been fully understood. The aim of this study was to evaluate the glucose metabolic profile using 18 F-FDG PET/CT imaging in patients with epilepsy. Methods: One hundred pediatric epilepsy patients who underwent 18 F-FDG PET/CT, MRI, and electroencephalography examinations were included. Fifteen age-matched controls were also included. 18 F-FDG PET images were analyzed by visual assessment combined with statistical parametric mapping (SPM) analysis. The absolute asymmetry index (jAIj) was calculated in patients with regional abnormal glucose metabolism. Results: Visual assessment combined with SPM analysis of 18 F-FDG PET images detected more patients with abnormal glucose metabolism than visual assessment only. The jAIj significantly positively correlated with seizure frequency (P , 0.01) but negatively correlated with the time since last seizure (P , 0.01) in patients with abnormal glucose metabolism. The only significant contributing variable to the jAIj was the time since last seizure, in patients both with hypometabolism (P 5 0.001) and with hypermetabolism (P 5 0.005). For patients with either hypometabolism (P , 0.01) or hypermetabolism (P 5 0.209), higher jAIj values were found in those with drug resistance than with seizure remission. In the post-1-y follow-up PET studies, a significant change of jAIj (%) was found in patients with clinical improvement compared with those with persistence or progression (P , 0.01). Conclusion: 18 F-FDG PET imaging with visual assessment combined with SPM analysis could provide cerebral glucose metabolic profiles in nonsurgical epilepsy patients. jAIj might be used for evaluation of clinical severity and progress in these patients. Patients with a prolonged period of seizure freedom may have more subtle (or no) metabolic abnormalities on PET. The clinical value of PET might be enhanced by timing the scan closer to clinical seizures.

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“…Abnormalities on EEG were classified by lobe and correlated with the abnormal PET region. The frequency of EEG epileptiform discharges convergent with the PET findings was analyzed for each patient and recorded as a spike count of either greater or less than 10 spikes/minute, a measure used in a prior study . In addition, the coexistence of focal or regional delta‐theta slowing was also noted.…”

Section: Methodsmentioning

confidence: 99%

“…In contrast, PET hypermetabolism is reported only rarely and its significance is unclear . Furthermore, there are no studies of seizure outcome after surgical resection of the hypermetabolic PET regions.…”

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confidence: 99%

PET hypermetabolism in medically resistant childhood epilepsy: Incidence, associations, and surgical outcome

et al. 2016

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SUMMARYObjective: We observed several children with medically resistant epilepsy demonstrating focal positron emission tomography (PET) hypermetabolism, a finding rarely reported and of questionable significance. We therefore retrospectively reviewed the incidence of hypermetabolic PET, and its relationship to electroencephalography (EEG) and magnetic resonance imaging (MRI) findings, and to the outcome of epilepsy surgery. Methods: We retrospectively reviewed 498 PET brain studies in patients with medically resistant childhood epilepsy for evidence of hypermetabolism. In patients with PET hypermetabolism, we correlated metabolic abnormality with the scalp EEG and MRI findings. In a subset of patients who underwent surgical resection, we further correlated the PET findings with histopathologic and surgical outcomes. Results: Focal PET hypermetabolism was identified in 33 (6.6%) of 498 studies. The region of hypermetabolism correlated with a spike count of ≥10 per minute in 26 of 32 concomitant scalp EEG studies and 18 of 21 lesions evident on MRI. In 17 patients who underwent surgical resection, PET hypermetabolism further correlated with regions revealing almost continuous epileptiform discharges on the intracranial EEG and with histopathologically malformative tissue. At a minimum follow-up of 1 year postsurgery (median 33 months), 7 (50%) of 14 patients had Engel's class I outcome, 4 patients had class II, and 2 had class III outcome, whereas one patient was unchanged. At last follow-up, seizure freedom was noted in five of seven patients with focal PET hypermetabolism alone versus three of eight patients with PET hypometabolism. Significance: Focal PET hypermetabolism is associated with high spike frequency on scalp EEG and can occur in the absence of ictal events during the peri-injection period. Correlation with intracranial EEG usually corroborates the highly epileptogenic pathophysiologic state. Cortical malformations constitute the most common pathologic substrate, and resection of the hypermetabolic PET region may facilitate favorable outcomes. These observations indicate that focal PET hypermetabolism is an important marker of the epileptogenic zone and may represent its epicenter. KEY WORDS: Intractable childhood epilepsy, High spike count, Resection of hypermetabolic PET region, Epilepsy surgery outcome, Epicenter of epileptogenic zone.

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Quantitative Analysis of Simultaneous EEG Features during PET Studies for Childhood Partial Epilepsy

Cited by 8 publications

References 22 publications

Significance of FDG-PET Hypermetabolism in Children with Intractable Focal Epilepsy

Significance of FDG-PET Hypermetabolism in Children with Intractable Focal Epilepsy

Glucose Metabolic Profile by Visual Assessment Combined with Statistical Parametric Mapping Analysis in Pediatric Patients with Epilepsy

PET hypermetabolism in medically resistant childhood epilepsy: Incidence, associations, and surgical outcome

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