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Marianna V. Spanaki, MD; Leonid Kopylev, PhD; Charles DeCarli, MD; William D. Gaillard, MD; Kore Liow, MD; Sharam Fazilat, BS; Shahin Fazilat, MD; Pat Reeves, BA; Susumu Sato, MD; Conrad Kufta, MD; William H. Theodore, MD

Arch Neurol. 2000;57:1447-1452.

Background  Fludeoxyglucose F 18 positron emission tomography (¹⁸F-FDG-PET) can detect focal metabolic abnormalities ipsilateral to the seizure focus in 80% of patients with temporal lobe epilepsy (TLE). Regions outside the epileptogenic zone can also be affected. We hypothesized that these remote regions might show altered metabolism, tending to return toward normal values, after surgery.

Design  Interictal preoperative and postoperative ¹⁸F-FDG-PET metabolism were compared in patients with refractory TLE. Based on pathological findings, disease was classified in the following 3 groups: mesial temporal sclerosis, mass lesions, and no pathological diagnosis. Quantitative PET data analysis was performed using the region-of-interest template previously described. Global normalization was used to adjust for the effect of antiepileptic medication changes. Data were analyzed by Wilcoxon signed rank test and analysis of variance.

Setting  The Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health.

Patients  Twenty-two patients with refractory TLE.

Results  Preoperatively, in all groups, cerebral metabolic rate for glucose was decreased ipsilateral to the resection site in inferior lateral temporal, inferior mesial temporal, and inferior frontal areas and thalamus. Postoperatively, in all groups, cerebral metabolic rate for glucose increased in ipsilateral inferior frontal area and thalamus. In the mesial temporal sclerosis group, we found a statistically significant increase in the contralateral thalamus.

Conclusion  Temporal lobe epilepsy is associated with extensive preoperative decreased metabolism in inferior lateral temporal, inferior mesial temporal, and inferior frontal areas and thalamus. Postoperatively, we found increased IF and thalamic metabolism. Seizures may have a reversible effect on brain areas connected with, but remote from, the epileptogenic cortex.

From the Clinical Epilepsy Section, Epilepsy Research Branch (Drs Spanaki, DeCarli, Gaillard, Liow, Fazilat, and Theodore and Mr Fazilat and Ms Reeves), Biometry and Field Studies Branch (Dr Kopylev), and EEG Section (Dr Sato) and Surgical Neurology Branch (Dr Kufta), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md; and Department of Neurology, Children's National Medical Center, Washington, DC (Dr Gaillard).

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