Metabolic patterns and seizure outcomes following anterior temporal lobectomy

IF 8.1 1区医学 Q1 CLINICAL NEUROLOGY Annals of Neurology Pub Date : 2019-01-04 DOI:10.1002/ana.25405

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

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引用次数: 26

Abstract

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.

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前颞叶切除术后的代谢模式和癫痫发作结果

目的探讨前颞叶(TL)切除术后单侧耐药内侧颞叶癫痫(MTLE)患者间期代谢模式、18f -氟脱氧葡萄糖正电子发射断层扫描(18FDG-PET)低代谢切除范围与癫痫发作结局的关系。方法选取82例海马硬化症或MRI表现正常、18FDG-PET低代谢一致、术后随访2年以上的患者为研究对象。每位患者的低代谢区与20名健康对照进行了鉴定(p <0.005)。切除的TL体积和切除的TL PET低代谢(TLH)体积通过术前和术后MRI扫描与间期18FDG-PET共登记计算。结果癫痫致侧TLH在代谢模式上存在显著差异，左侧MTLE患者同侧TLH的范围明显更大(p <0.001)，而右MTLE患者的对侧(CTL) TLH发生率显著高于右MTLE (p = 0.016)。在右MTLE患者中，CTL低代谢是不良癫痫发作结果的最强预测因子，与癫痫发作复发可能性增加5倍相关(优势比[OR] = 4.90, 95%可信区间[CI] = 1.07-22.39, p = 0.04)。在左侧MTLE患者中，单因素分析显示，切除同侧TLH的程度越大，癫痫复发率越低(p = 0.004);但其预测值未达到统计学意义(OR = 0.96, 95% CI = 0.90 ~ 1.02, p = 0.19)。根据MTLE偏侧的不同，代谢模式的差异可能代表了右侧与左侧MTLE患者不同的癫痫网络，可以指导术前咨询和手术计划。Ann Neurol 2019;中国生物医学工程学报(英文版);2019;35(5):591 - 591。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Neurology 医学-临床神经学

CiteScore

18.00

自引率

1.80%

发文量

270

审稿时长

3-8 weeks

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.

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