Complex partial seizures. Correlation of clinical and metabolic features
M. D. Holmes, K. Kelly and W. H. Theodore
Clinical Epilepsy Section, Institute of Neurological and Communicative Disorders and Stroke, Bethesda, Md 20892.
We compared metabolic patterns on 18F-2-deoxyglucose positron emission
tomography (PET) with closed circuit television and simultaneous
electroencephalographic ictal recordings of complex partial seizures in 48
patients. Closed circuit television and electroencephalographic data and
PET scans were scored by "blinded" raters. Of the 48 patients, 26 had
unilateral temporal; three, frontal; ten, ipsilateral frontotemporal; one,
frontoparietal; and five, temporoparietal hypometabolism; and three had
widespread hypometabolism affecting frontal, temporal, and parietal lobes.
patients with frontal hypometabolism alone had shorter ictal and postictal
durations, but involvement of multiple regions was associated with
prolonged seizures. Auras were more likely to be present in patients with
temporal hypometabolism alone, but an initial motionless stare did not
distinguish this group. However, other metabolic patterns did not predict
specific ictal clinical features. Vocalizations (formed or unformed) were
not more closely associated with frontal involvement. When hypometabolism
is multilobar, it may be difficult to use PET to distinguish between
complex partial seizures of frontal and temporal origin.
