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Edward B. Bromfield, MD; Lori Altshuler, MD; Deborah B. Leiderman, MD; Marshall Balish, MD, PhD; Terence A. Ketter, MD; Orrin Devinsky, MD; Robert M. Post, MD; William H. Theodore, MD

Arch Neurol. 1992;49(6):617-623.

Abstract
• Twenty-three patients with complex partial seizures were evaluated with ₁₈F-2-deoxyglucose positron emission tomography and with the Beck Depression Inventory. Five of 10 patients with left and zero of eight with right temporal electroencephalographic foci had depressive symptoms; one of five patients with poorly localized electroencephalographic foci also scored in the depressed range. Temporal, frontal, caudate, and thalamic normalized glucose metabolic rates among five patients with depressive symptoms and well-localized left temporal epileptogenic regions were compared with five patients without depressive symptoms but with similar electroencephalographic characteristics. Multifactorial analysis of variance yielded a significant nonlateralized mood by region interaction. Of nine individual regions compared, only inferior frontal cortex showed a significant difference in normalized regional metabolic rate between depressed and nondepressed patients. Metabolism in this region also distinguished patients with depressive symptoms from normal control subjects. Depressive symptoms in patients with complex partial seizures are associated with a bilateral reduction in inferior frontal glucose metabolism, compared with patients without depressive symptoms and normal control subjects. The frontal lobe hypometabolism observed in patients with depressions associated with epilepsy, Parkinson's disease, and primary affective disorder suggests that similar frontal lobe metabolic disturbances could underlie these conditions.

Author Affiliations
From the Medical Neurology Branch, National Institute of Neurological Diseases and Stroke (Drs Bromfield, Leiderman, Balish, Devinsky, and Theodore) and the Biological Psychiatry Branch, National Institute of Mental Health (Drs Altshuler, Ketter, and Post), National Institutes of Health, Bethesda, Md.

Footnotes
Accepted for publication February 10, 1992.

Presented in part at the annual meeting of the American Epilepsy Society, San Diego, Calif, November 1990.

Reprint requests to the Department of Neurology, Box 314, New England Medical Center, 750 Washington St, Boston, MA 02111 (Dr Bromfield).

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