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Michael W. L. Chee, MD; Harold H. Morris III, MD; Mohamed A. Antar, MD, PhD; Paul C. Van Ness, MD; Dudley S. Dinner, MD; Patrice Rehm, MD; Vincenta Salanova, MD

Arch Neurol. 1993;50(1):45-48.

Abstract
• Objective.
—Our goal was to determine the role of fludeoxyglucose F 18—positron emission tomography (¹⁸FDG-PET) and interictal temporal spikes in lateralizing the epileptogenic region in patients who (1) were diagnosed as having temporal lobe epilepsy based on clinical symptoms and exclusively temporal interictal spikes and (2) did not have a structural lesion on magnetic resonance imaging.

Design.
—This was a retrospective study of 40 consecutive patients fulfilling the above criteria who underwent ¹⁸FDG-PET scanning. A firm electrophysiologic diagnosis and 1 complete year of postsurgical follow-up, where applicable, were required. Outcome measures included surgical outcome and final electrophysiologic diagnosis.

Results.
—Unilateral, interictal temporal spikes (ITS) were present in 33 (82.5%) of 40 patients. Seven patients (17.5%) had bitemporal, independent spikes. Thirty-one (77.5%) of 40 patients had unilateral temporal hypometabolism (TH). Twenty-eight (70%) patients had concordant TH and ITS. One year after surgery, 31 of 33 patients with unilateral ITS were greatly improved; two of five who had bitemporal ITS showed similar improvement. In 28 patients, unilateral TH and unilateral ITS were concordant. The paired result always concurred with the final neurophysiologic assessment. Surgical outcome between patients with ¹⁸FDG-PET showing unilateral TH (26 of 30 greatly improved) and those not showing unilateral TH (six of eight greatly improved) was not significantly different.

Conclusion.
—In temporal lobe epilepsy not associated with a mass lesion, unilateral ITS are reliable lateralizing features and suggest a good surgical outcome. Use of ¹⁸FDG-PET provides corroborative lateralizing information but ¹⁸FDG-PET that fails to show unilateral TH does not preclude a good surgical outcome.

Author Affiliations
From the Section of Epilepsy and Sleep Disorders, Department of Neurology (Drs Chee, Morris, Van Ness, and Dinner) and the Department of Nuclear Medicine (Dr Antar), The Cleveland (Ohio) Clinic Foundation; the Department of Neurology, Tan Tock Seng Hospital, Singapore (Dr Chee); the Department of Radiology, Georgetown University Hospital, Washington, DC (Dr Rehm); and the Department of Neurology, Indiana University Medical Center, Indianapolis (Dr Salanova).

Footnotes
Accepted for publication July 20, 1992.

Reprint requests to Section of Epilepsy and Sleep Disorders, Department of Neurology, The Cleveland Clinic Foundation, Cleveland, OH 44195-5227 (Dr Morris).

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