Role of FDG-PET in Work-Up of Refractory Epilepsy Patients for Surgery in Two Epilepsy Centres in Sydney
Abstract number :
1.227
Submission category :
Year :
2000
Submission ID :
1385
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Armin Mohamed, Michael J Fulham, Andrew F Bleasal, Ernie S Somerville, Vilupillay Vignaendra, John C Walsh, Royal Prince Alfred Hosp, Camperdown, NS, Australia; Westmead Hosp, Westmead, NS, Australia.
Rationale: We evaluated the role of FDG PET in patients with refractory epilepsy who were referred from 2 comprehensive epilepsy programs in Sydney. In particular, the FDG PET findings when compared to the ultimate diagnosis and the effects of FDG PET findings on management. Method: We retrospectively reviewed all patients who had PET scanning as part of presurgical assessment. Between 92-99 228 patients were assessed for epilepsy surgery. 155 had FDG PET as part of their assessment. Localization of seizure onset was determined independent of PET by using electro-clinical and imaging data other than PET (MR, SPECT). The following data was also recorded: focal glucose hypometabolism on FDG PET, ultimate management, reason why surgery was not performed in some, and the effect of FDG PET on ultimate management. Results: Seizure onset (independent of PET) was assessed as temporal (71), frontal (19), parieto-occipital (15), central (4), extra-temporal but not further localized (4), lateralized to a hemisphere (25), and focal but not further localized (4). Surgery was performed in 49 patients (35 temporal, 13 extra-temporal, 1 hemispherectomy). Seizure onset and PET localization was concordant in 60/71(85%) of temporal, 11/19 (58%) of frontal, and 10/15 (75%) of parieto-occipital epilepsies. In temporal lobe epilepsy PET was done to confirm diagnosis (55%) or to help lateralize non-lateralized temporal epilepsy (32%). In the majority PET was concordant and led to surgery. Where seizure onset was outside the temporal lobe, PET was used to assist in localization. In 11/31 (35%) PET was concordant and led to invasive monitoring and/or surgery. In non-localized focal epilepsy the PET led to invasive monitoring in 2/26 (8%). In all 3 groups, the remainder of patients were deemed poor surgical candidates or refused surgery. Conclusion: FDG PET may assist in lateralizing non-lateralized temporal lobe epilepsy but rarely affected management in cases where the diagnosis was definite. In extra-temporal epilepsy it not infrequently provided further localizing information that led to invasive recordings. It rarely altered management in non-localized focal epilepsy.