Varduhi Cahill MD, Benjamin Sinclair PhD, Charles B. Malpas PhD, Anne M. McIntosh PhD, Zhibin Chen PhD, Lucy E. Vivash PhD, Marie F. O'Shea PhD, Sarah J. Wilson PhD, Patricia M. Desmond MD, Salvatore U. Berlangieri MBBS, Rodney J. Hicks MD, Christopher C. Rowe MD, Andrew P. Morokoff PhD, FRACS, James A. King PhD, FRACS, Gavin C. Fabinyi FRACS, Andrew H. Kaye MD, FRACS, Patrick Kwan MD, PhD, Samuel F. Berkovic MD, FRS, Terence J. O'Brien MD
{"title":"前颞叶切除术后的代谢模式和癫痫发作结果","authors":"Varduhi Cahill MD, Benjamin Sinclair PhD, Charles B. Malpas PhD, Anne M. McIntosh PhD, Zhibin Chen PhD, Lucy E. Vivash PhD, Marie F. O'Shea PhD, Sarah J. Wilson PhD, Patricia M. Desmond MD, Salvatore U. Berlangieri MBBS, Rodney J. Hicks MD, Christopher C. Rowe MD, Andrew P. Morokoff PhD, FRACS, James A. King PhD, FRACS, Gavin C. Fabinyi FRACS, Andrew H. Kaye MD, FRACS, Patrick Kwan MD, PhD, Samuel F. Berkovic MD, FRS, Terence J. O'Brien MD","doi":"10.1002/ana.25405","DOIUrl":null,"url":null,"abstract":"<div>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>We investigated the relationship between the interictal metabolic patterns, the extent of resection of <sup>18</sup>F-fluorodeoxyglucose positron emission tomography (<sup>18</sup>FDG-PET) hypometabolism, and seizure outcomes in patients with unilateral drug-resistant mesial temporal lobe epilepsy (MTLE) following anterior temporal lobe (TL) resection.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Eighty-two patients with hippocampal sclerosis or normal magnetic resonance imaging (MRI) findings, concordant <sup>18</sup>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 (<i>p</i> < 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 <sup>18</sup>FDG-PET.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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 <i>(p</i> < 0.001), whereas right MTLE patients had significantly higher rates of contralateral (CTL) TLH (<i>p =</i> 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, <i>p</i> = 0.04). In left MTLE patients, greater extent of resection of ipsilateral TLH was associated with lower rates of seizure recurrence (<i>p</i> = 0.004) in univariate analysis; however, its predictive value did not reach statistical significance (OR = 0.96, 95% CI = 0.90–1.02, <i>p</i> = 0.19).</p>\n </section>\n \n <section>\n \n <h3> Interpretation</h3>\n \n <p>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. Ann Neurol 2019; 1–10 <b>ANN NEUROL 2019;85:241–250.</b></p>\n </section>\n </div>","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":null,"pages":null},"PeriodicalIF":8.1000,"publicationDate":"2019-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ana.25405","citationCount":"26","resultStr":"{\"title\":\"Metabolic patterns and seizure outcomes following anterior temporal lobectomy\",\"authors\":\"Varduhi Cahill MD, Benjamin Sinclair PhD, Charles B. Malpas PhD, Anne M. McIntosh PhD, Zhibin Chen PhD, Lucy E. Vivash PhD, Marie F. O'Shea PhD, Sarah J. Wilson PhD, Patricia M. Desmond MD, Salvatore U. Berlangieri MBBS, Rodney J. Hicks MD, Christopher C. Rowe MD, Andrew P. Morokoff PhD, FRACS, James A. King PhD, FRACS, Gavin C. Fabinyi FRACS, Andrew H. Kaye MD, FRACS, Patrick Kwan MD, PhD, Samuel F. Berkovic MD, FRS, Terence J. O'Brien MD\",\"doi\":\"10.1002/ana.25405\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>We investigated the relationship between the interictal metabolic patterns, the extent of resection of <sup>18</sup>F-fluorodeoxyglucose positron emission tomography (<sup>18</sup>FDG-PET) hypometabolism, and seizure outcomes in patients with unilateral drug-resistant mesial temporal lobe epilepsy (MTLE) following anterior temporal lobe (TL) resection.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Eighty-two patients with hippocampal sclerosis or normal magnetic resonance imaging (MRI) findings, concordant <sup>18</sup>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 (<i>p</i> < 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 <sup>18</sup>FDG-PET.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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 <i>(p</i> < 0.001), whereas right MTLE patients had significantly higher rates of contralateral (CTL) TLH (<i>p =</i> 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, <i>p</i> = 0.04). In left MTLE patients, greater extent of resection of ipsilateral TLH was associated with lower rates of seizure recurrence (<i>p</i> = 0.004) in univariate analysis; however, its predictive value did not reach statistical significance (OR = 0.96, 95% CI = 0.90–1.02, <i>p</i> = 0.19).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Interpretation</h3>\\n \\n <p>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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Metabolic patterns and seizure outcomes following anterior temporal lobectomy
Objective
We investigated the relationship between the interictal metabolic patterns, the extent of resection of 18F-fluorodeoxyglucose positron emission tomography (18FDG-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 18FDG-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 18FDG-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. Ann Neurol 2019; 1–10 ANN NEUROL 2019;85:241–250.
期刊介绍:
Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.